CONGRESS ABSTRACT

Rationale: This case involves a patient presenting with STEMI complicated by cardiogenic shock and a single episode of ventricular fibrillation. Upon arrival in the cath lab, severe three-vessel coronary artery disease was diagnosed, including proximal LAD occlusion, critical long stenosis of the mid-distal circumflex artery, and proximal RCA subocclusion, with chronic total occlusion and microchannel in the mid-segment. Technical Resolution Urgent revascularization supported by Impella CP was implemented. A primary percutaneous coronary intervention was performed on the proximal LAD with the placement of two everolimus-eluting stents (3.5×23 mm and 3.0×8 mm). Revascularization of the mid-distal circumflex artery was subsequently achieved using an everolimus-eluting stent (2.5×38 mm). Finally, angioplasty of the RCA was carried out with the placement of two overlapping everolimus-eluting stents (2.5×48 mm and 3.0×15 mm). Clinical Course The patient was admitted to the Cardiac Intensive Care Unit, where a bedside echocardiogram showed mild-to-moderate left ventricular dysfunction, with akinesia of the anterior wall and septo-apical region, and hypokinesia of the lateral wall. The patient’s clinical condition progressively improved, allowing gradual weaning from the mechanical circulatory support device (Impella speed reduction from P6 to P2). Impella CP removal was performed in the cath lab. During this procedure, angiographic assessment of the femoral-iliac axis revealed a total occlusion of the right common femoral artery. Hence, a percutaneous transluminal angioplasty was successfully performed. After a hospital stay of approximately 10 days, the patient was discharged in good clinical condition and on optimized medical therapy. At a five-month follow-up, echocardiography demonstrated full recovery of left ventricular function. Clinical Implications and Perspectives This case highlights the critical role of mechanical circulatory support with Impella CP in managing cardiogenic shock, significantly impacting the patient’s prognosis. Notably, this case occurred in 2019, preceding evidence supporting the prognostic benefits of Impella in cardiogenic shock (e.g., the Danger Shock trial, 2024). Furthermore, routine angiographic evaluation of the femoral-iliac axis, the site of access for the Impella sheath, proved vital in diagnosing an occlusion of the right common femoral artery, a vascular complication that might otherwise have gone unrecognized.