Breakthrough in CHIP: cVAD-Supported Protected PCI at Soochow University

Case Overview Recently, the Department of Cardiovascular Medicine at The First Affiliated Hospital of Soochow University successfully performed a complex Protected PCI supported by a percutaneous ventricular assist device (cVAD) on a 73-year-old extreme-risk coronary artery disease patient.

Clinical Dilemma The patient presented with severe heart failure (extremely low LVEF). Coronary angiography confirmed Unprotected Left Main (ULM) disease combined with triple-vessel disease (including two CTOs and diffuse severe calcification in the LAD). Due to marginal baseline hemodynamics, routine PCI carried a prohibitive risk of severe slow flow or cardiac arrest during ballooning or rotablation. Furthermore, the patient was considered an absolute contraindication for CABG due to a prohibitively high surgical risk score.

Execution & Technical Details To mitigate the extreme risk of circulatory collapse, the team adopted an intervention strategy combining Mechanical Circulatory Support (MCS) with rotational atherectomy:

• Hemodynamic Support & LV Unloading: A cVAD was deployed into the left ventricle via femoral access. During the 85-minute complex intervention, the cVAD provided peak active flow of 2.7 L/min. This device effectively achieved Left Ventricular (LV) unloading, maintaining aortic root pressure and ensuring adequate end-organ perfusion.
• Rotablation & Revascularization: Under continuous cVAD protection, the surgical team safely utilized a Rotational Atherectomy system to modify the severe calcium burden in the LAD, followed by precise stent deployment. Throughout the procedure, the patient's blood pressure and heart rate remained stable, with no hemodynamic deterioration observed.

Clinical Summary Post-operative angiography demonstrated the restoration of TIMI 3 flow in the LAD. The patient was successfully weaned from the cVAD and discharged in stable condition. This case demonstrates that the prophylactic use of cVAD in CHIP patients with severe heart failure and heavy calcification can effectively maintain intraoperative hemodynamic stability, providing an essential safety window for high-risk rotablation and stenting procedures.