Tissue Plasminogen Activator to Resolve Elevated Purge System Pressure in a Catheter-Based Ventricular Assist Device

With the increasing use of percutaneous ventricular assist devices, understanding device-related complications becomes paramount. Although percutaneous ventricular assist devices such as the Impella offer crucial cardiac support, their use can also be associated with rare thrombotic complications. A patient with cardiogenic shock presented with anterior ST-segment elevation myocardial infarction. He had successful primary percutaneous coronary intervention to the left anterior descending artery with Impella support. Post procedure, he was transferred to the intensive care unit where the Impella device was noted to have an elevated purge pressure. Device replacement was not an option; therefore, we used a tissue plasminogen activator-based approach to successfully resolve this issue. This case report discusses an innovative use of tissue plasminogen activator to manage elevated purge pressure in a catheter-based ventricular assist device.