Protected Percutaneous Coronary Intervention With Impella 5.5 Pump in Severe Peripheral Artery Disease

Mechanical circulatory support (MCS) devices can be helpful to maintain hemodynamic stability during high-risk percutaneous coronary intervention (PCI). Iliofemoral arterial disease limits the use of transfemoral MCS devices. Impella 5.5, a surgical transaxillary MCS device, represents a viable option for MCS-protected PCI. We report a 74-year-old man with prior endovascular aneurysm repair (EVAR), severe peripheral artery disease (PAD), and newly diagnosed NSTEMI was found to have three-vessel and left main coronary disease with an ejection fraction (EF) of 13%. Due to aortoiliac occlusion, transfemoral MCS was not feasible. Instead, an Impella 5.5 was implanted via a right axillary artery graft, enabling successful orbital atherectomy and bifurcation PCI. In summary, axillary Impella 5.5 insertion is a viable option in anatomically complex patients where femoral access is contraindicated. This approach allows full left ventricular hemodynamic support for revascularization in otherwise inoperable patients.