Diminishing of Myocardial Damage Using Impella CP for ST-Elevation Myocardial Infarction Involving the Left Main Trunk

a large thrombus (Fig. 2A). Immediately after angiography, she developed ventricular fi brillation (VF) resistant to defi brillation. VA-ECMO was immediately inserted to get away from collapsed circulation. Then Impella CP was inserted before PCI for LV unloading and reducing myocardial damage. PCI was performed under mechanical supports using VA-ECMO and Impella CP via the left radial artery. Thrombus aspiration and the simultaneous kissing balloon dilatation were performed in the LMT with a 3.0-mm balloon (Sapphire NC, OrbusNeich Medical, Inc., Fort Lauderdale, FL, USA) from the LMT to LAD and a 2.5-mm balloon (Ryurei, Terumo Medical Corporation, Tokyo, Japan) from Acute myocardial infarction (AMI) with cardiogenic shock (CS) has poor prognosis, despite using mechanical circulatory support devices. An 85-year-old woman with ST-elevation myocardial infarction (STEMI) was transferred to our hospital. STEMI was caused by plaque rupture of the left main trunk (LMT) along with CS and aborted myocardial damage. She suffered cardiopulmonary arrest despite intra-aortic balloon pumping (IABP) support. Veno-arterial extra corporeal membrane oxygenation (VA-ECMO) and Impella CP were immediately inserted to support the circulation and left ventricular unloading. Then she underwent percutaneous coronary intervention (PCI) and managed to survive. Transthoracic echocardiogram in the subacute phase revealed a preserved left ventricular systolic function though the culprit lesion was in LMT and the area at risk for myocardial infarction was extremely large. Left ventricular unloading using Impella CP could contribute to preservation of cardiac function and diminishing of myocardial damage. balloon pumping, myocardial percutaneous coronary percutaneous ventricular assist device