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Institut Cardiovasculaire Paris Sud
Complication in angioplasty
The case I don’t want to have again
MC Morice, Massy France
Institut Cardiovasculaire Paris Sud
Cardiovascular risk-factors:• Smoking history• Hypertension • Diabetes mellitus
Syncope with chest pain 2 Syncope with chest pain 2 hours before admissionhours before admission
STEMI with persistent elevation ST inferior and STEMI with persistent elevation ST inferior and laterallateral
DR, m 60y
Cardiovascular history:
•Ischemic stroke (1980, without neurological sequel)
Institut Cardiovasculaire Paris Sud
ECG before PCI
• Inferior and Lateral ST segment elevation• Syncope, no chest pain• No clinical signs of shock
Institut Cardiovasculaire Paris Sud
AngiogramOM1 50-70%. Proximal RCA 100%
Institut Cardiovasculaire Paris Sud
Primary Angioplasty RCA occlusion
BHW wire + EXPORT thrombectomy system
Radial approach. AL1 6F
Result
Institut Cardiovasculaire Paris Sud
Angioplasty 2
Dilatation: Maverick 2/12mm ballon (10 atm)
BHW+BMW wires.
Result
Institut Cardiovasculaire Paris Sud
Angioplasty 3Stent DRIVER 3.0/30 mm (10 atm)
Result
Institut Cardiovasculaire Paris Sud
Angioplasty 4
Intrastent x3 dilatation: Mercury NC 3.0/10mm ballon (max 30 atm)
Temporary pacemeker for third degree AV block
Institut Cardiovasculaire Paris Sud
Stent DRIVER 3/24 Stent MICRO DRIVER 2.25/24 Stent MICRO DRIVER 2.5/18
IC Verapamil+
Angioplasty 5
Institut Cardiovasculaire Paris Sud
Final result
Unsuccessfull primary angioplasty RCA occlusion
Instable hemodynamic state: Intra-aortic ballon pumping
Institut Cardiovasculaire Paris Sud
After failed angioplasty:
• Echocardiography: • LVEF <30%, akinetic inferolateral segments of
LV• RV akinetic
•Tracheal intubation• Inotropic support• Intra-aortic ballon pumping•Temporary pacemaker
• Clinical signs of Cardiogenic shock requiring:
Institut Cardiovasculaire Paris Sud
ECG post angioplasty
Institut Cardiovasculaire Paris Sud
After 2 days on ICU:Progressive multi-organ
failure• PCI Treatment of OM1• Implantation of an Left ventricular assist:
IMPELLA
Institut Cardiovasculaire Paris Sud
Final evolution:
Final evolution: • Slow recovery to a Stable hemodynamic
stateEchocardiography: • Improved LVEF 50% inferoapical akinesia
Hospital discharge1 month after PCI
ECG after PCI obtuse marginale
ECG before discharge
Institut Cardiovasculaire Paris Sud
Summary
Clinical case: IMPELLA in cardiogenic shock
1. Primary angioplasty is not always succesful despite the use of thrombectomy and stenting and as in our case can result in clinical deterioration
2. Intra-aortic ballon pumping is not very effective in RV failure
3. The Impella device can be useful?
