PCI complications: Hemodynamic Support for Complex PCI: Difference between revisions
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Rapid [[hemodynamic|hemodynamic deterioration]] and death during [[PCI]] can occur due to [[hypotension]], [[decompensated heart failure]], [[shock]], or [[arrhythmias]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid20736470">{{cite journal| author=Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D | display-authors=etal| title=Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. | journal=JAMA | year= 2010 | volume= 304 | issue= 8 | pages= 867-74 | pmid=20736470 | doi=10.1001/jama.2010.1190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736470 }} </ref><ref name="pmid22935569">{{cite journal| author=O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J | display-authors=etal| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 14 | pages= 1717-27 | pmid=22935569 | doi=10.1161/CIRCULATIONAHA.112.098194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22935569 }} </ref> | Rapid [[hemodynamic|hemodynamic deterioration]] and death during [[PCI]] can occur due to [[hypotension]], [[decompensated heart failure]], [[shock]], or [[arrhythmias]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref><ref name="pmid20736470">{{cite journal| author=Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D | display-authors=etal| title=Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. | journal=JAMA | year= 2010 | volume= 304 | issue= 8 | pages= 867-74 | pmid=20736470 | doi=10.1001/jama.2010.1190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736470 }} </ref><ref name="pmid22935569">{{cite journal| author=O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J | display-authors=etal| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 14 | pages= 1717-27 | pmid=22935569 | doi=10.1161/CIRCULATIONAHA.112.098194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22935569 }} </ref> | ||
===Prevention=== | ===Prevention=== | ||
Usage of [[hemodynamic]] support devices can be helpful in specific circumstances nevertheless, its routine usage is not recommended to reduce [[cardiovascular disease|cardiovascular events]].<ref name="pmid20736470">{{cite journal| author=Perera D, Stables R, Thomas M, Booth J, Pitt M, Blackman D | display-authors=etal| title=Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. | journal=JAMA | year= 2010 | volume= 304 | issue= 8 | pages= 867-74 | pmid=20736470 | doi=10.1001/jama.2010.1190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20736470 }} </ref><ref name="pmid22935569">{{cite journal| author=O'Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J | display-authors=etal| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 14 | pages= 1717-27 | pmid=22935569 | doi=10.1161/CIRCULATIONAHA.112.098194 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22935569 }} </ref> | |||
====Hemodynamic Support Devices==== | ====Hemodynamic Support Devices==== | ||
*Intra-aortic balloon pump | *[[Intra-aortic balloon pump]] | ||
**Can provide minimal [[hemodynamic]] support for [[PCI]] but is capable of improving [[Coronary circulation|coronary]] and [[cerebral blood flow]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | **Can provide minimal [[hemodynamic]] support for [[PCI]] but is capable of improving [[Coronary circulation|coronary]] and [[cerebral blood flow]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
** | **But its usage is limited in [[patients]] with severe peripheral [[artery]] or [[aorta|aortic]] [[disease]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
**One of the advantages of this device is the small [[catheter]] size which reduces the risk of vascular access site [[Complication (medicine)|complications]]. Moreover, ease of use is another advantage of [[intra-aortic balloon pump]]. | |||
*[[Impella device|The Impella Percutaneous Left Ventricular–assist Devices]] | |||
**This device provides greater [[left ventricle|left ventricular]] support. | |||
**[[Impella device]] provides better [[hemodynamic]] support compared with [[Intra-aortic balloon pump|balloon counterpulsation]]. | |||
**Nevertheless, usage of this device is limited in [[patients]] with [[left ventricular thrombus]], [[aortic stenosis]], [[peripheral artery disease]], or [[aorta|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==== | ====2021 ACA Revascularization Guideline==== | ||
{|class="wikitable" | {|class="wikitable" | ||
Latest revision as of 14:41, 9 July 2022
Hemodynamic Support for Complex PC
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Pathophysiology
Rapid hemodynamic deterioration and death during PCI can occur due to hypotension, decompensated heart failure, shock, or arrhythmias.[1][2][3]
Prevention
Usage of hemodynamic support devices can be helpful in specific circumstances nevertheless, its routine usage is not recommended to reduce cardiovascular events.[2][3]
Hemodynamic Support Devices
- Intra-aortic balloon pump
- Can provide minimal hemodynamic support for PCI but is capable of improving coronary and cerebral blood flow.[1]
- But its usage is limited in patients with severe peripheral artery or aortic disease.[1]
- 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 [1] |
| Using an appropriate hemodynamic support device in the elective settings and among selected patients is reasonable to prevent hemodynamic compromise during PCI. |
References
- ↑ 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
|pmid=value (help). - ↑ 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.