Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may result in decreased cardiac output and tissue hypoperfusion during the procedure. There is also risk of decreased or absent perfusion due to complications of CTO PCI. Although supportive data are scarce, use of hemodynamic support devices may improve the safety of CTO PCI. Six hemodynamic support devices are currently available for clinical use in the United States (intra-aortic balloon pump, Impella 2.5/CP/5.5, veno-arterial extracorporeal membrane oxygenation, Tandem Heart, Protek Duo, and Impella RP). Determining the need for hemodynamic support depends on the patient’s baseline hemodynamics and the risk of PCI. Prophylactic hemodynamic support is in most cases recommended (if feasible) in patients who have both abnormal hemodynamics and are planned to undergo PCI of high-risk lesions. Hemodynamic support is not used prophylactically in most patients with (1) abnormal hemodynamics and undergoing a low-risk procedure or (2) normal hemodynamics and undergoing high-risk PCI, but should be immediately available for use in case of hemodynamic decompensation.
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