High-Risk PCI with Impella® Support and Atherectomy

Thom Dahle, MD, FACC, FSCAI, discusses the case of an 84-year-old male presenting with chest pain and shortness of breath on exertion. Dr. Dahle is an interventional cardiologist and director of the Valvular Heart Disease Program at CentraCare Heart & Vascular Center at St. Cloud Hospital in St. Cloud, Minnesota. 

The patient had a history of coronary artery disease with prior stenting of the circumflex. Upon presentation, a coronary angiogram revealed severe, heavily calcified narrowing at the ostium of his left circumflex involving the left main as well as the proximal LAD. His proximal and distal circumflex stents were still patent.

Concerned about the patient’s ability to tolerate an open-heart procedure, the heart team decided on a Protected PCI approach. “Oftentimes when I’m helping patients make this difficult decision, I often approach it as, ‘What I would do if it was my own family,’” Dr. Dahle states. “What makes this case very unique and special, is the patient was actually my father.”

“I was concerned, personally, about his ability to be able to recover from open-heart surgery,” Dr. Dahle explains. “And would that leave him with a better quality of life? Or, in his instance, possibly a worse quality of life?” Dr. Dahle discussed the case with his partner and a team of interventionalists and the decision was made to manage the case with coronary intervention with support from an Impella CP® heart pump. “It takes an enormous amount of trust in the technology to make this decision,” Dr. Dahle emphasizes.

Understandably not wanting to have the responsibility of performing the procedure on his own father, Dr. Dahle turned the care of his father over to his colleagues. The team performed a Protected PCI with orbital atherectomy of the left main into the LAD and the circumflex, and subsequent bifurcation stenting of the left main into the LAD and his dominant circumflex. The procedure went extremely well.

After the procedure, Dr. Dahle's dad returned to his active lifestyle and says, "I've never been as busy as I am now after I retired."