Ultra-Low Contrast PCI of LM-LAD with LV Mechanical Circulatory Support

Ziad A. Ali, MD, DPhil, presents a high-risk Protected PCI case study to illustrate imaging-guided PCI. He gave this presentation as part of the Cardiovascular Research Technologies (CRT) 2021 virtual annual symposium. 

The patient is a 57-year-old woman with coronary artery disease, several stents and advanced chronic kidney disease (CKD) presenting with persistent chest pain and shortness of breath. Angiography reveals severe LAD CAD extending to the LM. Given her CKD, Dr. Ali’s interventional plan was to get as complete revascularization as possible using a strategy of ultra-low contrast PCI of LM-LAD with LV mechanical circulatory support. “So we’re going to use our imaging tools to help us do this procedure and minimize all of the hazards but maximize the benefits,” he explains.

After using intravascular ultrasound (IVUS) to determine that the iliofemoral anatomy was suitable for placement of an Impella CP®, Dr. Ali placed the Impella® heart pump and created a wire-based metallic silhouette of the coronary tree using Philips' Dynamic Coronary Roadmap. “The Dynamic Coronary Roadmap…that’s going to help us guide the entire intervention without using dye,” he explains. “It’s a pretty cool technology by Philips which actually takes the dye injection shots that we already used and paints it onto the x-ray system so that it will move with you in the views that you’ve already taken.”

Dr. Ali describes the procedure and his use of IVUS, Dynamic Roadmap, and the MLD MAX approach. “So we did an ultra-low contrast angiogram with a minimal contrast PCI and achieved a complete revascularization,” Dr. Ali explains. “We used only the diagnostic angiogram. We used only the Dynamic Coronary Roadmap. The IVUS allowed us to place the Impella. And what I haven’t talked about a lot is the Impella itself. The Impella allowed us to do this and take as much time as we need to perform a complete revascularization without really any doubt in my mind that we’ve got an optimal PCI in the LAD and we haven’t caused any harm in the circumflex.”

Dynamic Coronary Roadmap is developed by Philips Medical Systems