Acute intraventricular thrombosis of an impella LP 5.0 device in an ST-elevated myocardial infarction complicated by cardiogenic shock.

A 58-year-old male patient, suffering from an acute anterior ST-elevated myocardial infarction, developed cardiogenic shock, despite an optimal revascularization and hemodynamic support through the use of an intra-aortic balloon pump and inotropic pharmacological agents. Additional support was provided by a left ventricular assistance device Impella LP 5.0 (Abiomed, Europe GmbH). Device failure occurred 27 hours after implantation due to an acute thrombosis of the Impella inflow portion. This major adverse event might have occurred due to an inflammatory status in the cardiogenic shock context, a pre-existing intraventricular thrombus that could have been sucked up inside the Impella, and/or a subtherapeutic anticoagulation. There are very few data regarding this type of complication. Further studies are therefore needed to assess the frequency of such a complication and the means to avoid it.