Supported percutaneous coronary intervention using a novel 6-Fr intra-aortic balloon pump catheter via the brachial artery in a nonagenarian patient with an abdominal aortic aneurysm.

摘要

Intra-aortic balloon pump (IABP) counterpulsation is a useful hemodynamic assist device during complex percutaneous coronary intervention (PCI) in patients with poor left ventricular function; however, the presence of an abdominal aortic aneurysm poses a problem, because insertion via the femoral artery may cause distal embolism and aneurysm rupture. A 92-year-old man with unstable angina was admitted to our hospital. Coronary angiography revealed chronic total occlusion of the proximal left anterior descending artery and severe stenosis of the left circumflex artery (LCX). The left ventricular ejection fraction was 36%. He also had an infrarenal abdominal aortic aneurysm with a diameter of 55 mm. Supported PCI was performed for the management of the LCX lesion. A novel 6-Fr IABP catheter was inserted via the left brachial artery. The lesion was successfully dilated, and a 3.0 x 13 mm Cypher(R) stent was placed. After the PCI procedure, the IABP catheter was retrieved in the catheter laboratory, and the patient was discharged after 7 days. When a femoral approach is contraindicated in PCI, 6-Fr IABP catheter insertion via the brachial artery is feasible and effective.