Single-access percutaneous coronary intervention with IMPELLA CP support using a 16F sheath in refractory ventricular...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Complex cardiac arrest cases often require combined veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella left-ventricular unloading, and urgent percutaneous coronary intervention (PCI).
• Vascular access can be a significant procedural challenge in these high-risk patients.
• Traditional single-access Impella-PCI methods present trade-offs between workflow efficiency and bleeding risk, especially when radial access is not an option.

Purpose of the Study:

• To present a rescue strategy for achieving single-access Impella-supported PCI in cases where radial access is unobtainable.
• To describe a coaxial sheath configuration that facilitates complex interventions while minimizing bleeding complications.

Main Methods:

• A coaxial 16 Fr/14 Fr/6 Fr sheath configuration was employed in the left common femoral artery.
• A 16 Fr Medikit sheath was placed, followed by coaxial insertion of a 14 Fr peel-away sheath for Impella CP implantation.
• A 6 Fr sheath was advanced through the Impella sheath to enable percutaneous coronary intervention (PCI).

Main Results:

• The described coaxial strategy successfully enabled single-access Impella-supported PCI in a patient with refractory ventricular fibrillation and coronary artery occlusion.
• The procedure involved VA-ECMO via right femoral cannulation and Impella CP implantation through the coaxial sheath system.
• Successful stent deployment was achieved via the 6 Fr sheath, and all sheaths except the 16 Fr were removed post-procedure without bleeding complications.

Conclusions:

• A coaxial 16 Fr/14 Fr/6 Fr femoral approach provides a safe and effective method for single-access Impella-supported PCI.
• This technique combines procedural efficiency with a reduced risk of bleeding, particularly valuable when radial access is not feasible.
• This strategy offers a viable solution for complex cardiac arrest interventions requiring mechanical circulatory support and revascularization.