A clinical study of a novel approach of puncture catheterization in extra-corporeal membrane oxygenation combined with intra-aortic balloon counter pulsation assisted percutaneous coronary intervention in treatment of complex and high-risk coronary heart disease

  AIM  To evaluate the safety and feasibility of a novel puncture strategy for complex high-risk coronary intervention using an intra-aortic balloon counter pulsation (IABP) and large-diameter percutaneous coronary intervention (PCI) guiding catheter placed in the ipsilateral femoral artery and the extracorporeal membrane pulmonary oxygenation (ECMO) placed contralateral femoral artery and vein.

  METHODS  This was a retrospective study. A total of 7 patients were enrolled, in whom the left femoral artery and femoral vein were used to cannulate by ECMO (arterial cannulation 15F diameter and venous cannulation 17F diameter), the right superficial femoral artery was used to cannulate by IABP (7F arterial sheath) and the right common femoral artery was used to cannulate by PCI femoral sheath (7F arterial sheath). The hemostasis at arterial and venous puncture sites of ECMO was performed by preplaced ProGlide vascular suture. Angioseal vascular blocker was used to stop the bleeding at the PCI and IABP femoral artery punctures. All puncture sites were evaluated by ultrasound to observe the success rate of puncture sites, complication rates and the feasibility of completing PCI.

  RESULTS  Among the 7 patients, 6 were male and 1 was female, with a mean age of 57±12 years, combined with hypertension in 5 cases (71%), diabetes mellitus in 3 cases (43%), chronic kidney disease in 1 case (14%), hyperlipidemia in 4 cases (57%), stroke in 1 case (14%) and peripheral vascular disease in 4 cases (57%). The results showed 100% success rate of left femoral vein and bilateral femoral arteries puncture, and 100% completion rate of PCI procedures. Only one patient had a small subcutaneous hematoma, less than 2cm in diameter. No serious vascular complications were observed during hospitalization in all patients.

  CONCLUSION  In patients with complex and high-risk coronary heart disease, when ECMO combined with IABP is required to maintain hemodynamic stability and a large-diameter guiding catheter is needed to puncture the femoral artery to complete a complex PCI procedure, a surgical puncture strategy of ipsilateral superficial femoral artery placement of IABP, common femoral artery placement of a large-diameter (7F) PCI arterial sheath, and contralateral femoral artery and femoral vein placement of ECMO can be used, and this protocol is safe and feasible.