Simultaneous therapy with pressure-controlled intermittent coronary sinus occlusion and left ventricular support during high-risk percutaneous coronary intervention: a case report.

Background: Previous studies in patients with ST-segment elevation acute myocardial infarction treated with primary angioplasty and supported by the PiCSO® system have shown a modest yet significant absolute reduction in the infarcted myocardial area. However, the simultaneous use of PiCSO® and Impella CP® during high-risk percutaneous coronary intervention (PCI) procedures has not been reported. Case summary: A 76-year-old Caucasian man presented with severe and highly calcified left main coronary disease and severely depressed left ventricular function. As coronary bypass surgery was deemed prohibitive, successful PCI was performed with the simultaneous use of PiCSO® and Impella CP® to mitigate damage from distal microembolization and provide mechanical circulatory support to the left ventricle during the high-risk PCI procedure. Discussion: Our case exemplifies for the first time the simultaneous use of PiCSO® and Impella CP® during a high-risk PCI. This case suggests the feasibility and safety of combining both devices for mechanical haemodynamic and microcirculatory support simultaneously in specific cases during high-risk PCI, offering hope for reducing post-PCI myocardial damage in a selected population of patients.