Successful Impella 5.0 Catheter Removal in the Setting of Left Ventricular Thrombus With Use of the Sentinel Cerebral Protection Device

TL;DR

A patient with heart complications successfully had an Impella catheter removed using a Sentinel device, which captured a blood clot fragment, preventing neurological issues.

Contribution

This is the first reported case of a Sentinel cerebral protection device capturing a left ventricular thrombus during Impella removal.

Findings

The Sentinel cerebral protection device captured a thrombus fragment during Impella removal.

The patient did not experience neurological complications after the procedure.

The case suggests the Sentinel device may reduce embolic risks during Impella removal in specific scenarios.

Abstract

Mechanical circulatory support devices, such as the Impella catheter (Abiomed, Danvers, Massachusetts), continue to become more commonplace in patients undergoing high-risk percutaneous coronary intervention (PCI) or those in cardiogenic shock. Thrombus in the left ventricle is a contraindication to Impella placement. Here, we present a patient with an anterior ST elevation myocardial infarction who underwent primary PCI with subsequent development of cardiogenic shock followed by Impella placement, who then later developed an LV thrombus. The Impella was removed after placement of a Sentinel cerebral protection device (Boston Scientific, Massachusetts). The left carotid filter of the Sentinel captured a thrombus fragment. The patient did not have any neurological compromise. This case represents the first report of actual capture of LV thrombus by a Sentinel system in this context. The case suggests the potential value of the Sentinel cerebral protection device to lower the risk of an embolic event during Impella removal in selective clinical scenarios.

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