High–Risk Percutaneous Coronary Intervention with Impella Support

If you have been diagnosed with coronary artery disease (CAD), your doctor may recommend an open-heart surgical procedure called coronary artery bypass grafting or CABG. During CABG, a healthy artery or vein from the body is grafted to the blocked coronary artery, giving way to bypass the blocked portion. This opens a new pathway for blood to flow to the heart and correct the problem. However, not all patients can tolerate open-heart surgery. Typically, if you have severe CAD, myocardial ischemia, a single unblocked artery or reduced left ventricular function and other complicating medical conditions, you may not be a good candidate for CABG. In these cases, patients considered at higher risk are better candidates for minimally invasive Percutaneous Coronary Intervention (PCI).

During a PCI with Impella support procedure, your cardiologist will insert a narrow tube either into your wrist or groin and thread it to the affected artery where a balloon catheter is inflated to make room for a stent. The stent will hold the artery open. The inflation also pushes the plaque or build up against the artery wall. If there is too much plaque, your cardiologist may have to remove some using a rotating tip to trim it away. This is called atherectomy or the removal of plaque to open the site for the stent.

The stent, a flexible mesh coil, allows for normal blood flow to return in the artery. Over time, scar tissue will form over the stent to hold it in place. You will be prescribed medication to take that will keep blood clots from developing inside the stent. Some cardiologists use drug-eluding stents that are coated in a medication that prevents too much scar tissue from growing and causing a blockage. Your doctor will discuss which stent is best for you.

Myocardial ischemia or decreased blood flow and oxygen to the heart muscle can worsen during balloon insertions, stent placement and introduction of contrast solutions, so a pump is used ensure proper blood flow. An intra-aortic balloon pump (IABP) or Impella dhelps maintain stable heart function and circulation during PCI.

How to prepare for a PCI
Do not eat or drink after midnight on the evening before the procedure. Take your regular medications, but only have a small amount of water to take pills. If you take blood thinners or have diabetes, talk with your doctor about any special instructions.

You will mostly likely be able to go home the same or next day. You will not be allowed to drive yourself home, so please bring a driver. You will be able to resume driving and normal activities based on your cardiologist’s recommendations.

Over the coming weeks, you will see improvement in your overall health, including increased energy and ability to exercise, improved breathing and reduced chest pain.