case_images: PMC8674504_01
case_images: Coronary angiography. Left panel: chronic total occlusion of the mid left circumflex coronary artery. Right panel: chronic total occlusion of the proximal right coronary artery.
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case_images: PMC8674504_01_fcvm-08-784912-g0001.jpg
case_images: F1
case_images: Coronary angiography showed chronic total occlusions (CTOs) of the proximal right coronary artery (RCA) and mid left circumflex (LCx) coronary artery (Figure 1).
case_images: Impella CP parameters during the procedure. (A) the Placement Signal is an approximation of the central aortic pressure (mmHg) with the gray area representing the systolic and diastolic pressures and the blue line the mean aortic pressure. The red box highlights in magnified form the 1-min pressure drop and reduced pulsatility during the VF episode and the immediate increase of pressure and pulsatility after spontaneous termination of the tachyarrhythmia. (B) This curve represents the mean Impella flow (L/min) during the procedure. A short flow peak (a) is visible at maximal compromised cardiac function during VF due to proportional reversed response to compensate for the reduced cardiac flow. Impella flow is managed based on the Performance (P-Level) (C), which corresponds to Motor Current (mA) (D) and motor speed (rpm) (E) and can be manually adjusted. High flow requires high Motor Current and Motor Speed. During the VF episode, Impella Performance and Flow were manually and gradually reduced (from P8 down to P3) in anticipation to DC shock and were increased again as soon as the patient stabilized after VF termination.
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case_images: PMC8674504_01_fcvm-08-784912-g0002.jpg
case_images: F2
case_images: The Impella CP parameters during the procedure and the hemodynamic support provided by the device during VF are shown in Figure 2.
case_images: Left circumflex coronary artery after PCI. Final result after implantation of two drug-eluting stents using the T-stent technique.
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case_images: PMC8674504_01_fcvm-08-784912-g0003.jpg
case_images: F3
case_images: PCI of the LCx and obtuse marginal branch was successfully performed with implantation of two drug-eluting stents (DES) using a T-stent technique (Figure 3).
case_images: Right coronary artery after PCI. Left panel: result after predilatation. A severe stenosis of the marginal branch ostium is shown. Note the Supercross 120  microcatheter that was used to wire the branch. Right panel: final result after deployment of the Tryton side branch stent in the marginal branch and multiple drug-eluting stent implantation in the right coronary artery.
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case_images: PMC8674504_01_fcvm-08-784912-g0004.jpg
case_images: F4
case_images: Ohio, USA) in the marginal branch and multiple DES in the main vessel with a good angiographic result (Figure 4). Of note, after the short VF episode, a stable hemodynamic status was maintained by the Impella CP support during this complex procedure.