Percutaneous Coronary Intervention Through the Impella
System Sheath. A New Strategy to Limit Number of Access
Sites in High Risk Patients Volume 2 - Issue 3
Taha Ahmed, Hafeez ul Hassan Virk and E Dean Nukta*
Department of Cardiology, Fairview Hospital, Cleveland Clinic, USA
Received: September 25, 2019; Published: October 21, 2019
Corresponding author: E Dean Nukta, Department of Cardiology, Fairview Hospital, Cleveland Clinic, USA
a. A 14 Fr access arterial sheath was introduced in the right
femoral artery percutaneously. The Impella CP system was
prepared and flushed.
b. Over an exchange wire, the device was advanced under
fluoroscopy across the aortic valve, wire was removed.
c. The device was connected to the driver unit and the
device position was confirmed on fluoroscopy. Impella system
was started and hemodynamic support was established (Figure
3).
Figure 3:
d. A 6Fr sheath was introduced into the Impella access
sheath next to the 9 Fr Impella catheter and a guiding catheter
was advanced under fluoroscopy and the vessel was engaged.
e. Angioplasty with placement of drug eluting stent to
proximal LAD stenosis and mid LCx was performed with 0%
residual stenosis.
f. The sheath was removed and hemostasis was established
using perclose closure device.
g. There was no bleeding at the end of the procedure. The
patient was returned to the recovery room in a stable condition.
h. There was no access site complication in 6 weeks follow
up visit (Figure 4).
a. We present a case of a diabetic, hypertensive male with
severe complex coronary artery disease who underwent high
risk percutaneous coronary intervention (PCI) via the Impella
system sheath with a favorable outcome (Figure 5).
b. It is one of the first known cases of this innovative nature
that brings into consideration the importance of dual vascular
access via the Impella system sheath.
c. The patient tolerated the procedure well with no
complications at the follow up visit.
d. The case was discussed with the heart team, which has
become the standard for high risk and complex decisions.
e. In high risk coronary artery disease patients, PCI can
be performed safely via the Impella system sheath therefore
avoiding unnecessary vascular access and associated
complications.