Minimizing the risk of contrast-induced nephropathy and hemodynamic collapse during chronic total occlusion percutaneous coronary intervention with a percutaneous left ventricular assist device

Autor: Julien Lemoine, Satoru Mitomo, Enrico Poletti, Damiano Regazzoli, Max Amor, Antonio Colombo, Mauro Carlino, Lorenzo Azzalini, Daisuke Hachinohe, Ozan M. Demir
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
Contrast-induced nephropathy
Contrast Media
030204 cardiovascular system & hematology
Coronary Angiography
Risk Assessment
Ventricular Function
Left
Ventricular Dysfunction
Left
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Renal Insufficiency
Chronic
Ultrasonography
Interventional
Impella
Aged
business.industry
Hemodynamics
Percutaneous coronary intervention
Shock
General Medicine
Acute Kidney Injury
medicine.disease
Treatment Outcome
Coronary Occlusion
Ventricular assist device
Chronic Disease
Conventional PCI
Cardiology
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Kidney disease
Zdroj: Cardiovascular Revascularization Medicine. 19:712-716
ISSN: 1553-8389
DOI: 10.1016/j.carrev.2018.01.013
Popis: Candidates for percutaneous coronary revascularization are becoming progressively older and more complex. A combination of factors related to the patient, lesion, and/or hemodynamic conditions may increase the risk of adverse events. Therefore, when a high-risk procedure is identified, it is crucial to provide the patient with adequate support in order to safely perform percutaneous coronary intervention (PCI). We report the case of a 77-year-old man with moderate left ventricular dysfunction and stage IV chronic kidney disease who underwent successful recanalization of a chronically occluded left anterior descending artery. The procedure was performed with a micro-axial percutaneous left ventricular assist device (Impella 2.5) in order to provide stable hemodynamics, and with minimal contrast medium administration (14 ml) to minimize the risk of acute kidney injury. Despite the use of aggressive techniques (including rotational atherectomy), the patients remained stable throughout the procedure and did not experience contrast-induced nephropathy or periprocedural myocardial infarction, and was discharged two days later. Moreover, we provide recommendations to assist interventional cardiologist safely perform complex and high-risk PCI, with particular attention to renal function preservation.
Databáze: OpenAIRE
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