Related Experiment Video

Updated: Jun 30, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|June 29, 2026
PubMed

Insights

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.

Keywords:
Haemodynamic supportHigh-risk PCIIABPImpella CPLeft main diseaseMultivessel CADProtected PCIReduced LVEFVA-ECMO

More Related Videos

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...