Immediate Use of Impella CP for High-Risk Percutaneous Coronary Intervention After Repair of Thrombosed Aortic Coarctation

Aortic coarctation represents up to 7% of congenital heart diseases and is associated with hypertension and coronary artery disease, which continues to be the leading cause of death even after successful surgical repair. However, there is limited knowledge of managing both conditions, especially in the setting of an acute coronary syndrome. We herein present the case of a 53-year-old man with a history of hypertension who initially presented with an ST-elevation myocardial infarction successfully treated with thrombolysis and hemodynamic compromise. During angioplasty, an incidental finding of aortic coarctation was noted. After a thorough evaluation by the heart team, it was determined that percutaneous revascularization with ventricular support was necessary due to the high surgical risk. Aortic coarctation repair was performed first, followed by successful angioplasty with the placement of an Impella CP device through the newly implanted aortic stent. To our knowledge, this is the first reported case of a patient with both STEMI and aortic coarctation treated sequentially and using only a percutaneous approach. It is also the first reported case where a ventricular assist device (VAD) was used to support high-risk PCI in a patient with a repaired aortic coarctation.