PMC7457323_01
Attempt to unkink the Impella CP catheter by snaring its tip and pulling it toward the left subclavian artery. After unkinking, we could not advance the catheter into the left ventricle.
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F1
Amplatz GooseNeck snare (ev3) was advanced through the hemostatic Y-adapter and the guiding catheter to the aortic arch and captured the tip of the ICP device (the ICP pigtail) and pulled the ICP distal tip into the left subclavian artery to unfold the device (Figure 1).
The resnared Impella CP tip is dragged by the snare connected to the Judkins Right 4 (6 Fr) guiding catheter into the ascending aorta.
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F2
After unfolding the ICP tip, we could still not advance the ICP into the left ventricle. At that point, we elected to use the guiding catheter to lead the pigtail into the left ventricle - initially into the ascending aorta (Figure 2) and then into the left ventricle (Figure 3).
The resnared Impella CP tip is dragged by the snare connected to the JR4 guiding catheter into the left ventricle.
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F3
After unfolding the ICP tip, we could still not advance the ICP into the left ventricle. At that point, we elected to use the guiding catheter to lead the pigtail into the left ventricle - initially into the ascending aorta (Figure 2) and then into the left ventricle (Figure 3).
The Impella CP is released in the left ventricle in adequate position and good function.
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F4
Finally, the snare was released, the ICP maintained its position in the left ventricle (Figure 4), and full MCS was resumed.
Contralateral injection of the arteriotomy site (AS) closure with digital subtraction using 1 mL of contrast.
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F5
In view of the design of the ICP repositioning sheath, we used the previously described Trojan-Horse method, followed by a double Proglide (Abbott) closure of the arteriotomy site. In view of the thrombocytopenia and coagulopathy, we elected to use adjunctive contralateral wiring from the left femoral artery and imaging of the arteriotomy site after closure (Figure 5).