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Optimizing protected PCI strategies in the setting of chronic kidney disease and advanced coronary artery disease: a

Mario Iannaccone1, Jerzy Sacha2,3, María Monteagudo-Vela4

  • 1Department of Cardiology, Turin Nord Emergency Hospital, Piazza Donatori di Sangue 3, 10100 Torino TO, Italy.

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

Insights

Mechanical circulatory support (MCS) with a microaxial flow pump (mAFP) can improve procedural safety during percutaneous coronary intervention (PCI) for high-risk patients. This approach helps manage complex coronary artery disease (CAD) and reduces adverse outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Patients with chronic coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF) are high-risk for percutaneous coronary intervention (PCI).
  • Complex coronary anatomy, comorbidities like chronic kidney disease, and impaired cardiac reserve increase procedural risks, including hemodynamic instability and acute kidney injury (AKI).

Purpose of the Study:

  • To highlight the role of mechanical circulatory support (MCS) in enhancing procedural safety for high-risk patients undergoing PCI.
  • To demonstrate the utility of a microaxial flow pump (mAFP) in managing complex CAD in a vulnerable population.

Main Methods:

  • A case presentation of an elderly male patient with multivessel CAD, reduced LVEF, and multiple comorbidities.
  • Utilized Impella™ (a type of mAFP) for mechanical circulatory support during percutaneous coronary intervention (PCI).

Main Results:

  • Impella™-supported PCI provided left ventricular unloading and augmented cardiac output, optimizing procedural safety.
  • The use of MCS potentially mitigated the risk of AKI and expanded revascularization options for this high-risk patient.

Conclusions:

  • Mechanical circulatory support (MCS) is a valuable strategy for managing high-risk patients with complex CAD undergoing PCI.
  • Impella™-assisted PCI can improve outcomes and safety in patients with severely reduced LVEF and multiple comorbidities.

Keywords:
Coronary artery diseaseLeft ventricle support devicePercutaneous coronary intervention

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