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Explore Extreme High-Risk PCI with Impella: Complex Multivessel CAD with Severe LV Dysfunction. with 788 views, 31 likes, and 15 comments. Experience the impact of this video content that has captured audience attention.

A 71-year-old patient with severe ischemic cardiomyopathy, high-risk multivessel coronary artery disease, and severe left ventricular systolic dysfunction presented with acute decompensated heart failure and an acute coronary syndrome with elevated cardiac biomarkers. Myocardial viability imaging demonstrated preserved viability in the apical and apical-inferior myocardial segments, supporting a strategy of complete revascularization. LHC showed a CTO of LAD and RCA. Given the patient’s severely reduced LV function and complex coronary anatomy, Impella-assisted high-risk PCI was performed. The procedure included successful recanalization and PCI of chronic total occlusions (CTOs) in both the LAD and RCA. An XB 3.5-45 guide catheter was used for the left coronary system, while a JR4 guide catheter was used for the right coronary artery. A combination of Runthrough and PT guidewires, along with GuideLiner support, was utilized to cross the lesions and facilitate device delivery through heavily calcified vessels. For the LAD CTO, a side-branch blocking technique through the diagonal branch was employed to facilitate successful guidewire passage into the occluded LAD. Shockwave intravascular lithotripsy (IVL) was then used for calcium modification before stent implantation, ensuring optimal lesion preparation and stent expansion. The procedure resulted in successful Impella-supported multivessel revascularization of the LAD and RCA territories, achieving restoration of coronary flow while maintaining hemodynamic stability throughout this complex high-risk intervention.

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