Case 161: Manual of PCI - "Getting to the heart"

A patient presented with progressive dyspnea and was found to have NSTEMI and decompensated heart failure with LV ejection fraction of 10-15%. He had 90% distal left main stenosis and a CTO of the right coronary artery. He was turned down for CABG and referred for high-risk PCI. He had severe peripheral arterial disease precluding femoral insertion of an Impella CP. Bilateral radial access was obtained, however there was significant ostial left subclavian stenosis. The Impella sheath was inserted percutaneously via right axillary access after placing 2 Perclose sutures. The left main was successfully treated with provisional stenting into the LAD after wiring both the LAD and the circumflex. The Impella CP was removed and hemostasis was achieved after tightening the Perclose sutures. The patient had an uneventful recovery.