Percutaneous left ventricular assist device in high risk percutaneous coronary intervention

High-risk candidates for percutaneous coronary intervention (PCI) may include patients with severe multi-vessel coronary artery disease, unprotected left main coronary artery stenosis, or last patent conduit with a stenosis, especially in patients with a left ventricular (LV) ejection fraction of ≤35% (1-4). In addition, the condition and co-morbidities of the patient should be taken into consideration. Traditionally, revascularization in these patients could be better accomplished with coronary artery bypass graft (CABG) surgery; however, sometimes these patients are high-risk surgical candidates, have advanced age and/or have poor distal targets for bypass surgery (5). PCI in these patients is a viable option, however, episodic interruption of blood flow to the target coronary artery in these high-risk patients during contrast dye injections, balloon inflation and stent implantation may result in a decrease in LV performance raising procedural morbidity and/or mortality (3,4,6). Currently, it is thought that hemodynamic support devices like the Impella (Abiomed, Danvers, Massachusetts) percutaneous left ventricular assist device (PLVAD) or intra-aortic balloon pump (IABP) may provide support during high-risk PCI (2,3,7-9).