PCI complications: Hemodynamic Support for Complex PCI
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Hemodynamic Support for Complex PC
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editors-In-Chief: Anahita Deylamsalehi, M.D.
Rapid hemodynamic deterioration and death during PCI can occur due to hypotension, decompensated heart failure, shock, or arrhythmias.
Usage of hemodynamic support devices can be helpful in specific circumstances nevertheless, its routine usage is not recommended to reduce cardiovascular events.
Hemodynamic Support Devices
- Intra-aortic balloon pump
- Can provide minimal hemodynamic support for PCI but is capable of improving coronary and cerebral blood flow.
- But its usage is limited in patients with severe peripheral artery or aortic disease.
- One of the advantages of this device is the small catheter size which reduces the risk of vascular access site complications. Moreover, ease of use is another advantage of intra-aortic balloon pump.
- The Impella Percutaneous Left Ventricular–assist Devices
- This device provides greater left ventricular support.
- Impella device provides better hemodynamic support compared with balloon counterpulsation.
- Nevertheless, usage of this device is limited in patients with left ventricular thrombus, aortic stenosis, peripheral artery disease, or aortic disease.
- Extracorporeal membrane oxygenation and the Tandem-Heart devices
- These devices are rarely used in order to support complex PCI
2021 ACA Revascularization Guideline
|Class 2b Recommendation, Level of Evidence: B-R |
|Using an appropriate hemodynamic support device in the elective settings and among selected patients is reasonable to prevent hemodynamic compromise during PCI.|
- ↑ 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
- ↑ 2.0 2.1 Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D; et al. (2010). "Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial". JAMA. 304 (8): 867–74. doi:10.1001/jama.2010.1190. PMID 20736470.
- ↑ 3.0 3.1 O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J; et al. (2012). "A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study". Circulation. 126 (14): 1717–27. doi:10.1161/CIRCULATIONAHA.112.098194. PMID 22935569.