[High risk PTCA: prevention and treatment of cardiogenic shock with mechanical assist systems]

Vessel occlusion during of after PTCA integrates the risk of pump failure if the ischemia volume is great as compared to the remaining myocardium. In so-called high-risk PTCA a risk stratification by means of risk scores such as "Bergelson Score" is mandatory. To encounter the risk of pump failure the application of mechanical cardiac assist devices such as balloon pumps, Hemopump or percutaneous applicable cardio-pulmonary support (pCPS) can be considered. To counteract ischemia during balloon inflation active perfusion balloons can be applied. The latter systems are simple and effective, however the duration of application is restricted to the balloon inflation period. Cardiac assist devices are more aggressive. While the results of intaaortic ballon pump in combination with high-risk PTCA are unsatisfying, Hemopumps and pCPS were alternatives, although the Hemopump is still under investigation. Our own results on 42 patients with high-risk PTCA demonstrate an acceptable 8.6% hospital mortality rate, however an unsatisfying intermediate survival rate since a complete revascularisation in this subset of patients with extensive coronary disease and, frequently, total vessel occlusion is mostly impossible.