CORVAD 4.0-assisted complex left main PCI in high-risk acute coronary syndrome with SCAI stage C cardiogenic shock: A...

Temporary left ventricular support may be considered when cardiogenic shock and complex left main percutaneous coronary intervention (PCI) overlap, but the procedure depends on more than pump placement alone. We describe an 80-year-old man with high-risk acute coronary syndrome, ongoing ischemia for more than 12 h, SCAI stage C cardiogenic shock, left ventricular ejection fraction of 39%, and severe distal left main bifurcation disease in a left-dominant coronary system. Coronary angiography was performed through the right distal radial artery. Before femoral cannulation, the same radial access was used as an adjunct to obtain right iliofemoral angiographic information. After the femoral route was judged suitable, CORVAD 4.0 was implanted through the right femoral artery and provided approximately 2.1 L/min of support at level S5. PCI was performed through the right distal radial artery using a 7F EBU 3.0 guiding catheter. Intravascular ultrasound-guided DK-crush PCI was completed with final TIMI 3 flow. The device was kept in place for short-term intensive care support and removed once hemodynamics and end-organ perfusion had improved sufficiently, after fever and coagulase-negative staphylococcal blood culture growth raised concern for possible device- or access-related infection. Infection was subsequently controlled, and the patient was discharged after 11 days. This case illustrates a stepwise approach to temporary support, access assessment, complex PCI, and timely device removal when the clinical risk profile changes.