Mechanical Circulatory Support with iVAC2L During High-Risk Percutaneous Coronary Intervention: A Case Report

Background: High-risk percutaneous coronary intervention (HR-PCI) in patients with severe left ventricular (LV) systolic dysfunction and complex coronary artery disease may be complicated by abrupt intraprocedural hemodynamic deterioration. Temporary mechanical circulatory support may be considered after individualized Heart Team assessment; however, clinical experience with the pulsatile iVAC2L device remains limited. Case Presentation: An 84-year-old man presented with inferior ST-segment-elevation myocardial infarction, acute decompensated heart failure, pulmonary edema, and an LV ejection fraction of 10-15%. Coronary angiography (CAG) showed a presumed chronic total occlusion of the right coronary artery (RCA) and critical disease of the left main (LMCA), left anterior descending (LAD), and left circumflex (LCx) arteries. Preparation for coronary artery bypass grafting was initiated, but clinical deterioration prompted PCI. The first attempt was aborted after cardiac arrest during coronary wiring. Following stabilization and repeat Heart Team assessment, iVAC2L-supported HR-PCI was performed. During 60 min of active pump support, five stents were implanted in the LMCA, LAD, and LCx. The patient remained conscious and hemodynamically stable without vasopressors. LV ejection fraction was approximately 20% at discharge after six hospital days, and the patient was transferred to inpatient rehabilitation. Conclusions: In this selected patient, iVAC2L-supported HR-PCI was technically feasible and was associated with maintained intraprocedural hemodynamic stability. A single case cannot establish comparative safety or efficacy; prospective studies are required to define patient selection, procedural protocols, and clinically meaningful outcomes.