14th Experts Live CTO September 2nd - 3rd, 2022 - Mainz, Germany Main Session - Breakfast Symposium by Abiomed Benefit of pMCS support in CHIP – case illustration Kambis Mashayekhi, Lahr, Germany Room: Guteberg Hall (Auditorium) - Saturday 7:30 Chair: Carlo di Mario, Florence, Italy

1. Benefit of pMCS support in
CHIP - Case illustration
Kambis Mashayekhi
Heart Center Lahr

2. Affiliation/Financial Relationship
• Consulting Fees/Honoraria
Company
• Abboth, Abiomed, Ashai Intecc, Astra
Zeneca, Biotronik, Boston, Cardinal
Health, Daiichi Sankyo, Medtronic,
Schockwave, SIS, Teleflex,Terumo,
Disclosures
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or
affiliation with the organization(s) listed below.

3. Patients history
• NSTEMI, with heart failure and decompensation in a patient with
severe impaired lv-function
• Global hypokinesia, EF 25%
• Paroxysmal atrial fibrillation and oral anticoagulation (CHA2DS2-
VAScore: 8)
• CVRF: DM II, art. hypertension, hypercholesterinemia, smoker

4. Diagnostic angiogram

5. Diagnostic angiogram

6. Coronary Intervention

7. Bridging collateral engagement
Blood pressure
collapsed
Indication for
protected PCI

8. Insertion of the Impella sheet through the femoropopliteal bypass

9. but……Impella could not be advanced

10. Changed to Innowi Wire 270cm for and 14F Edwards Sheet
But… Impella could not be advanced at
the kinking of the illiaca artery

11. Changed to a 14F Cook Sheet, with difficulties to advance

12. But,……Impella could not be advanced

13. 18F Gore DrySeal Flexsheat, but failed to advance

14. 18F Gore DrySeal Flexsheat

15. Now, the Impella could be advanced

16. 18F Gore DrySeal Flexsheat with 8F Guide

17. Passage of the CTO and 1.5mm burr for plaque modification

18. Final result

19. Kambis Mashayekhi
CHIP Case with chronic kidney disease

20. • 62y old male, since weeks severe angina, walking distance <200m
• NSTEMI 03/2019 with severe 3 VD with left main stenosis, but severe impaired
LV-function - indication for CABG
• CVRF: IDDM II, hypertension, hyperlipidemia
• Diabetic nephropathy: GFR 29ml/min/1.73m2
• Patient transferred to our center as he definitely refuses surgery
Clinical History

21. Diagnostic angiogram 08.04.2019

22. Diagnostic angiogram 08.04.2019

23. Heartteam Discussion
• STS-Mortality Score:1.31%
• Morbidity/Mortality Score: 24.37%
• Euroscore II: 2.92%
• Severe diabetic nephropathy
• Severe impaired LV

24. Low contrast PCI with Impella CP
6cc contrast

25. Low contrast PCI with Impella CP

26. Low contrast PCI with Impella CP

27. Low contrast PCI with Impella CP

28. Low contrast PCI with Impella CP

29. Low contrast PCI with Impella CP

30. Low contrast PCI with Impella CP

31. Low contrast PCI with Impella CP

32. Low contrast PCI with Impella CP

33. Low contrast PCI with Impella CP

34. Low contrast PCI with Impella CP

35. Low contrast PCI with Impella CP

36. Low contrast PCI with Impella CP
12cc contrast

37. GFR and Creatinine dynamic

38. Follow up 23.06.2021 (26 months later)

39. Follow up 23.06.2021 (26 months later)