Related Experiment Video
Updated: Aug 5, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Impella-Assisted High-Risk Percutaneous Coronary Intervention in Cardiogenic Shock With Low-Flow, Low-Gradient Aortic
Douni Roger1, Waleed Shaker1, Zan Siddiqi1
1University of Michigan/Sparrow Hospital Lansing Michigan USA.
Insights
Percutaneous mechanical circulatory support, like Impella, helps high-risk patients with cardiogenic shock and complex coronary artery disease undergo necessary procedures when surgery is not an option. This approach can improve outcomes in challenging cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Patients with cardiogenic shock, low-flow, low-gradient aortic stenosis, and multivessel coronary artery disease pose significant therapeutic challenges, especially when ineligible for surgery.
- Non-ST-elevation myocardial infarction, acute decompensated heart failure, and acute kidney injury further complicate management in this high-risk demographic.
Purpose of the Study:
- To highlight the utility of percutaneous mechanical circulatory support (M CS) in facilitating high-risk percutaneous coronary intervention (PCI) for patients with cardiogenic shock and complex coronary artery disease.
- To present a case study demonstrating the successful application of Impella 5.5 support in a patient ineligible for surgical revascularization.
Main Methods:
- A 69-year-old male patient with cardiogenic shock, low-gradient aortic stenosis, and multivessel coronary artery disease, deemed inoperable, was treated with Impella 5.5 mechanical circulatory support.
- The patient subsequently underwent high-risk PCI to the left anterior descending artery while supported by the Impella device.
Main Results:
- Successful weaning from Impella 5.5 mechanical circulatory support was achieved post-PCI.
- The patient experienced recovery of renal function and optimization of guideline-directed medical therapy.
- Discharge included a wearable cardioverter-defibrillator and a plan for follow-up echocardiography.
Conclusions:
- Percutaneous mechanical circulatory support plays a crucial role in enabling high-risk PCI in patients with cardiogenic shock, pseudo-severe aortic stenosis, and multivessel coronary artery disease when surgical options are contraindicated.
- This case underscores the potential of MCS to improve outcomes in complex cardiovascular conditions where traditional surgical approaches are not feasible.
Abstract:
Patients with cardiogenic shock, low-flow, low-gradient aortic stenosis, and multivessel coronary artery disease who are ineligible for surgery present a major therapeutic challenge. Percutaneous mechanical circulatory support may facilitate revascularization in this high-risk population. A 69-year-old man presented after a mechanical fall and was found to have non-ST-elevation myocardial infarction, acute decompensated heart failure, low-gradient aortic stenosis, and multivessel coronary artery disease. Echocardiography showed a left ventricular ejection fraction (LVEF) of 25%-30% with mild left ventricular dilation and mildly reduced right ventricular systolic function. Laboratory testing demonstrated elevated troponin, markedly elevated B-type natriuretic peptide, and acute kidney injury. Chest radiography revealed bilateral pleural effusions and mild atelectasis. Surgical revascularization was not pursued, as the patient was considered at prohibitive operative risk by cardiothoracic surgery. The patient developed cardiogenic shock requiring Impella 5.5 support and subsequently underwent Impella-assisted high-risk PCI to the left anterior descending artery. He was successfully weaned from mechanical support, renal function recovered, and guideline-directed medical therapy was optimized. He was discharged with a wearable cardioverter-defibrillator and planned repeat echocardiography. This case highlights the role of percutaneous mechanical circulatory support in enabling high-risk PCI in patients with cardiogenic shock, pseudo-severe aortic stenosis, and multivessel coronary artery disease when surgical options are not feasible.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care