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Interventional Cardiology
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A Review of Bleeding Risk with Impella-supported High-risk Percutaneous Coronary Intervention

Published Online: December 29th 2020 Heart International. 2020;14(2):Online ahead of journal publication
Authors: George W Vetrovec, Amir Kaki, Thom G Dahle
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Article Information

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there is limited randomized data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps (IABP), but increasingly Impella heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk-benefit considerations, with Impella-related bleeding risk being a major factor that can impact decisions for planned use. While bleeding risk related to large bore access is a concern, published data on the risk has been quite variable. Thus, the goal of this article is to provide a comprehensive review of reports describing bleeding and vascular complications for Impella-supported HR-PCI.


High-risk percutaneous coronary intervention (PCI), haemodynamic support, PCI bleeding complications, mechanical circulatory support, PCI vascular complications, percutaneous left ventricular assist device (pVAD)


**This manuscript has been accepted for publication, but not yet copyedited or typeset, and may be subject to minor changes during the production process**

Article Information:

George Vetrovec has acted as a consultant for Abiomed, Merck and the FDA. Amir Kaki has acted as a proctor and speaker for Abiomed. Thom G Dahle has acted as a proctor and consultant for Abiomed.

Compliance With Ethics

This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.

Review Process

Double-blind peer review.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published.


George W Vetrovec, MD, MACC, MSCAI, 3126 W. Cary St. #693, Richmond, VA 23221-3504 USA.
E: gvetrovec@gmail.com


No funding was received in the publication of this article.

Open Access

This article is freely accessible at touchCARDIO.com  © Touch Medical Media 2020.



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