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

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.