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Updated: Dec 17, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

Single-access during Impella hemodynamic support utilizing the Railway system.

Matthew G Whitbeck¹, Jeffrey W Chambers¹

¹Allina Health, Metropolitan Heart and Vascular Institute, Minneapolis, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions

|July 1, 2020

Summary

A novel single-access technique simplifies procedures combining mechanical circulatory support and percutaneous coronary intervention. This method enhances guide catheter manipulation for complex cardiac interventions.

Keywords:

complex percutaneous coronary intervention coronary artery disease mechanical circulatory support

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Area of Science:

Interventional Cardiology
Cardiovascular Devices
Medical Engineering

Background:

Mechanical circulatory support (MCS) and percutaneous coronary intervention (PCI) are critical for managing complex cardiac conditions.
Existing single-access techniques using the Impella sheath have limitations in sheath size and guide catheter manipulation.
Alternative access sites may not be feasible or desirable in certain patient populations.

Observation:

A previous single-access technique involved placing a 7 French (F) sheath through the Impella 14F sheath hemostatic valve.
This approach was constrained to smaller sheaths and presented challenges in guide catheter manipulation.
Difficulty and multiple attempts were noted with the prior method.

Findings:

A new single-access technique is described utilizing the Impella 14F sheath.
This method employs the Railway Sheathless Access System for a standard 7F guide catheter.
The guide catheter is placed sheathless through the Impella 14F sheath hemostatic valve.

Implications:

This technique may overcome limitations of previous single-access methods for combined MCS and PCI.
It potentially allows for improved guide catheter manipulation and broader applicability.
Further evaluation is needed to confirm its safety and efficacy in clinical practice.