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Intraaortic balloon pump support during coronary angioplasty. Initial experience
E C Osterne1, G A Alexim, V P da Motta
1Hospital das Forças Armadas, Brasília, Brazil.
Insights
Intraaortic balloon pumps (IAoB) combined with percutaneous coronary angioplasty offer hemodynamic stability for high-risk patients. This approach enables successful procedures, improving clinical outcomes in complex coronary artery disease cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- High-risk patients with acute ischemic syndromes often present complex coronary artery disease.
- Surgical revascularization may be contraindicated in these patients.
- Percutaneous coronary angioplasty (PCA) alone may be insufficient for hemodynamic support.
Purpose of the Study:
- To evaluate the efficacy and safety of using an intraaortic balloon (IAoB) in conjunction with coronary angioplasty.
- To assess the feasibility of PCA with IAoB support in high-risk patients unsuitable for surgery.
Main Methods:
- Fourteen high-risk patients underwent PCA, often with stenting, supported by an IAoB.
- Patients had severe coronary artery disease, including multivessel disease and unprotected left main lesions.
- Many patients had significantly reduced left ventricular ejection fraction (<30%).
Main Results:
- Procedures achieved 100% initial success.
- Two patients experienced severe bleeding during sheath removal.
- After 12 months, 4 patients were asymptomatic, and others were clinically controlled, with two late deaths.
Conclusions:
- The combined use of IAoB and PCA provides crucial hemodynamic stability.
- This strategy facilitates successful intervention in high-risk patients with acute ischemic syndromes.
- IAoB support is a valuable adjunct for complex PCI in high-risk populations.
Objective:
To evaluate the use of the intraaortic balloon (IAoB) in association with coronary angioplasty in high-risk patients.
Methods:
Fourteen high-risk patients unresponsive to clinical therapy and with formal contraindication to surgical revascularization were treated by coronary angioplasty, most of which was followed by stenting. All procedures were performed with circulatory support with the IAoB. This study reports the early results and the late findings after 12 months of follow-up. Six patients had multivessel coronary disease; of these, four had left main equivalent lesions and two had unprotected left main coronary artery disease, one of whom had severe "end-vessel" stenosis and the other was a patient with Chagas' disease with single-vessel lesion. Eleven patients had a left ventricular ejection fraction < 30%.
Results:
In 100% of the patients, the procedures were initially successful. Two patients had severe bleeding during the withdrawal of the left femoral sheath. At the end of twelve months, 4 patients were asymptomatic and the others were clinically controlled. There were two late deaths in the 7th and 11th months.
Conclusion:
The combined use of the intraaortic balloon pump and percutaneous coronary angioplasty in high-risk patients with acute ischemic syndromes provides the necessary hemodynamic stability to successfully perform the procedures.