Percutaneous left ventricular assist device to support PCI of unprotected left main coronary artery disease

Although percutaneous coronary intervention (PCI) has long surpassed coronary artery bypass grafting (CABG) as the most common revascularization strategy in patients with coronary artery disease [1], left main coronary artery disease (LMCD) is regarded a relative contraindication to PCI [2]. This lack of enthusiasm was related to studies showing that although balloon angioplasty was effective in 94% of such high-risk procedure, long-term survival rate was dismal (36% after 3 years) in patients with unprotected LMCA [3], reinforcing CABG as therapy of choice in these patients [4]. However, recent improvements in stent technology and delivery systems, including drug-eluting stents and use of effective antiplatelet agents, have expanded the frontiers of PCI [1]. Thus, recent reports demonstrated satisfactory acute and long-term outcome after percutaneous management of protected, as well as unprotected LMCD [5, 6]. Nonetheless, the risk of ischaemic complications during PCI in unprotected LMCD is of major concern and potentially responsible for the increase in mortality in this special subgroup of patients. Parallel to the breakthrough in stent technology, supportive techniques have been developed for limiting ischaemia during high-risk angioplasty. Of these, percutaneous left ventricular assist devices (pVAD) have been demonstrated to support the circulation during high-risk procedures [7]. With the advent of these recent techniques, we considered PCI in a patient with a severe lesion in the distal portion of the left main coronary artery (LMCA) who refused surgery. The patient underwent successful