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Updated: Jun 30, 2026
10:28
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Contemporary evidence in protected percutaneous coronary intervention: a case-based review
Ovidio De Filippo1,2, Jürgen Leick3, Giuseppe Tarantini4
1Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza (AOU), Corso Bramante 88/90, 10126 Turin, Italy.
Summary
Protected percutaneous coronary intervention (PCI) using microaxial flow pumps (mAFP) offers a safe strategy for high-risk patients with severe left ventricular dysfunction. This approach enables complete revascularization, improving outcomes in complex cases unsuitable for surgery.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Mechanical Circulatory Support
Background:
- High-risk percutaneous coronary intervention (PCI) in patients with severely reduced left ventricular ejection fraction (LVEF) poses a significant risk of hemodynamic collapse.
- Current European Society of Cardiology (ESC) guidelines (Class IIb-III) support PCI for patients with severe left ventricular (LV) dysfunction, complex disease, or surgical ineligibility.
Purpose of the Study:
- To illustrate the expanding role of protected PCI with microaxial flow pumps (mAFP) in high-risk patients meeting Class IIb-III ESC criteria.
- To demonstrate how mAFP-assisted PCI can facilitate complete and optimized revascularization safely in patients with severe LV dysfunction and complex coronary artery disease.
Main Methods:
- Case presentation of a 66-year-old male with severe LV dysfunction and multivessel/left main disease undergoing protected PCI.
- Utilized microaxial flow pumps (mAFP) for percutaneous mechanical circulatory support (MCS) during PCI.
- Employed contemporary evidence supporting mAFP to maintain forward flow and ventricular unloading.
Main Results:
- Protected PCI with mAFP successfully maintained forward flow and ventricular unloading, minimizing hemodynamic instability.
- The approach allowed for meticulous lesion preparation, imaging-guided optimization, and complex PCI techniques (e.g., bifurcation) while preserving perfusion.
- The procedure was performed safely, enabling complete and optimized revascularization.
Conclusions:
- Protected PCI using mAFP is a safe and effective option for carefully selected high-risk patients with severe LV dysfunction and complex coronary disease.
- This strategy bridges a therapeutic gap, enabling complete revascularization and potentially promoting early functional recovery.
- Impella-supported high-risk PCI represents a valuable tool in contemporary revascularization practice.
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