Mutallimov Mirza, Er Fikret, Gassanov Natig
Department of Internal Medicine II, Klinikum Idar-Oberstein, 55743 Idar-Oberstein, Germany.
Department of Internal Medicine I, Klinikum Gütersloh, Reckenberger Str 19, 33332 Gütersloh, Germany.
Eur Heart J Case Rep. 2022 Aug 16;6(8):ytac335. doi: 10.1093/ehjcr/ytac335. eCollection 2022 Aug.
The use of an Impella pump catheter has advanced substantially in the last few years due to the simple insertion procedure and smaller device size. However, its use is still associated with some risks and complications. Here, we report a device fracture as a rare complication that occurred during the device extraction a few days after the initial insertion.
A 74-year-old man with cardiogenic shock due to acute non-ST-segment elevation myocardial infarction presented to our hospital, and he was transferred to the cath lab for emergency percutaneous coronary intervention (PCI). An Impella CP pump was inserted without any complication prior to PCI. After successful PCI, the patient was transferred to the intensive care unit with device left for continued haemodynamic support. After 3 days, as the patient's condition remarkably improved, we tried to remove the device. However, a persistent mechanical resistance hindered the further catheter retraction; therefore, a decision was made to remove the catheter under fluoroscopy. Indeed, the fluoroscopy revealed a broken distal part of the pump at the level of the ascending aorta. The retained catheter tip was eventually snared with a snare catheter and removed without any complication.
An Impella microaxial pump may improve the overall outcome by providing haemodynamic support in critically ill patients. However, its application is not without complications. Intravascular device tip fracture, as demonstrated in this case report, is a rarely reported complication. The use of a snare catheter can be an option in retrieving a broken pump.
由于插入过程简单且设备尺寸较小，近年来Impella泵导管的使用有了显著进展。然而，其使用仍与一些风险和并发症相关。在此，我们报告一例罕见的并发症——设备断裂，该情况发生在初始插入几天后的设备取出过程中。
一名74岁男性因急性非ST段抬高型心肌梗死导致心源性休克入住我院，随后被转至导管室进行紧急经皮冠状动脉介入治疗（PCI）。在PCI之前插入了Impella CP泵，未出现任何并发症。PCI成功后，患者被转至重症监护病房，保留该设备以持续提供血流动力学支持。3天后，随着患者病情显著改善，我们尝试取出该设备。然而，持续的机械阻力阻碍了导管进一步回撤；因此，决定在荧光透视引导下取出导管。实际上，荧光透视显示泵的远端部分在升主动脉水平处断裂。最终，用圈套导管套住残留的导管尖端并顺利取出，未出现任何并发症。
Impella微轴泵通过为重症患者提供血流动力学支持可能会改善总体预后。然而，其应用并非没有并发症。如本病例报告所示，血管内设备尖端断裂是一种很少报道的并发症。使用圈套导管可能是取出断裂泵的一种选择。
