Related Experiment Videos
Percutaneous support devices for high risk or complicated coronary angioplasty
A M Lincoff1, J J Popma, S G Ellis
1Department of Internal Medicine (Cardiology Division), University of Michigan Medical Center, Ann Arbor 48109-0022.
Insights
Mechanical circulatory support devices enhance high-risk coronary angioplasty safety. These percutaneous techniques improve patient tolerance during balloon occlusion and maintain hemodynamic stability, expanding revascularization options for complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary angioplasty indications have broadened to include complex patients with unstable ischemic syndromes, severe multivessel disease, and impaired left ventricular function.
- High-risk angioplasty necessitates adjuncts to manage balloon occlusion intolerance and potential hemodynamic instability.
Purpose of the Study:
- To review mechanical approaches that support patients during high-risk coronary angioplasty.
- To evaluate the role of percutaneous techniques in improving procedural safety and expanding treatment eligibility.
Main Methods:
- Review of percutaneous mechanical circulatory support techniques used in coronary angioplasty.
- Description of devices including intraaortic balloon pump, anterograde coronary perfusion, coronary sinus retroperfusion, percutaneous cardiopulmonary bypass, and left ventricular assist devices.
Main Results:
- Intraaortic balloon pump offers hemodynamic support and reduces myocardial workload.
- Anterograde and retroperfusion techniques mitigate ischemia during prolonged balloon inflations.
- Percutaneous cardiopulmonary bypass provides robust hemodynamic support, applicable prophylactically or emergently.
Conclusions:
- Mechanical support devices, despite potential complications, can enhance coronary angioplasty safety.
- These adjuncts may enable revascularization in patients previously considered unsuitable for the procedure.
Abstract:
Indications for coronary angioplasty have expanded to include patients with unstable acute ischemic syndromes, severe multivessel coronary artery disease and impaired left ventricular function. Several mechanical approaches have been developed as adjuncts to high risk coronary angioplasty to improve patient tolerance of coronary balloon occlusion and maintain hemodynamic stability in the event of complications. These percutaneous techniques include intraaortic balloon counterpulsation, anterograde transcatheter coronary perfusion, coronary sinus retroperfusion, cardiopulmonary bypass, Hemopump left ventricular assistance and partial left heart bypass. The intraaortic balloon pump provides hemodynamic support and ameliorates ischemia by decreasing myocardial work; it may be inserted for periprocedural complications or before angioplasty in patients with ischemia or hypotension. Anterograde distal coronary artery perfusion may be accomplished passively through an autoperfusion catheter or by active pumping of oxygenated blood or fluorocarbons through the central lumen of an angioplasty catheter. Synchronized coronary sinus retroperfusion produces pulsatile blood flow via the cardiac veins to the coronary bed distal to a stenosis. Both perfusion techniques limit development of ischemic chest pain and myocardial dysfunction in patients undergoing prolonged balloon inflations. Percutaneous cardiopulmonary bypass provides complete systemic hemodynamic support which is independent of intrinsic cardiac function or rhythm and has been employed prophylactically in very high risk patients before coronary angioplasty or emergently for abrupt closure. These and newer support devices, while associated with significant complications, may ultimately improve the safety of coronary angioplasty and allow its application to those who would otherwise not be candidates for revascularization.