Navigating high-risk PCI with axillary impella support: a case report

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Cardiovascular Devices

Background:

• High-risk percutaneous coronary intervention (PCI) in patients with complex coronary artery disease and impaired left ventricular function presents significant challenges.
• Mechanical circulatory support with devices like Impella is crucial for maintaining hemodynamic stability during these procedures.
• Traditional femoral artery access may be contraindicated in patients with peripheral vascular disease.

Observation:

• A case report details a 68-year-old male with severe multivessel coronary artery disease and bilateral iliofemoral artery disease.
• Due to difficulties with femoral access, axillary artery access was utilized for Impella CP device insertion.
• The patient underwent successful complex lesion revascularization with rotational atherectomy and stenting.

Findings:

• The axillary artery approach facilitated successful Impella CP device implantation for mechanical circulatory support.
• The patient remained hemodynamically stable throughout the high-risk PCI procedure.
• The patient experienced an uncomplicated recovery post-procedure.

Implications:

• Axillary artery access is a feasible and clinically useful alternative for Impella insertion in select patients unsuitable for femoral access.
• This approach expands therapeutic options in advanced interventional cardiology for complex cases.
• Meticulous planning and surgical expertise are essential for safe and effective axillary access in this setting.