Elective vs provisional IABP with left main stenting

Elective vs provisional IABP with left main stenting

Elective vs provisional IABP with left main stenting: IABP (intra aortic balloon pump) may be a useful tool while performing unprotected left main stenting. Unprotected left main is one which is not protected by a patent coronary artery bypass graft or collaterals. Briguori C and colleagues from the lab of Antonio Colombo came out with a few criteria for the use of elective IABP in the setting of unprotected LMCA (left main coronary artery) interventions [1]. They suggested that elective IABP support is to be considered if it is an LMCA bifurcation lesion, if the left ventricular ejection fraction is less than forty percent, in cases of unstable angina, in the presence of critical right coronary lesions and when atherectomy is being planned. In their analysis they found that those eight percent of those who did not have elective IABP had severe hemodynamic instability while it occurred in none of those who had elective IABP support. Intra procedure major adverse cardiac event (MACE) was also higher in those who did not have elective IABP support (9.5% vs 1.5%). Major adverse cardiac events considered were severe hypotension and/or shock, myocardial infarction, urgent bypass surgery, and death.

Reference

1. Carlo Briguori, Flavio Airoldi, Alaide Chieffo, Matteo Montorfano, Mauro Carlino, Giuseppe Massimo Sangiorgi, Nuccia Morici, Iassen Michev, Ioannis Iakovou, Giuseppe Biondi-Zoccai, Antonio Colombo. Elective versus provisional intraaortic balloon pumping in unprotected left main stenting. Am Heart J. 2006;152:565-72.