key: cord-299784-xxxdjfbc authors: Bettari, Luca; Pero, Gaetano; Maiandi, Cristian; Messina, Antonio; Saccocci, Matteo; Cirillo, Marco; Troise, Giovanni; Conti, Elena; Cuccia, Claudio; Maffeo, Diego title: Exploring Personal Protection During High-Risk PCI in a COVID-19 Patient: Impella CP Mechanical Support During ULMCA Bifurcation Stenting date: 2020-04-10 journal: JACC Case Rep DOI: 10.1016/j.jaccas.2020.03.006 sha: doc_id: 299784 cord_uid: xxxdjfbc The correct management of patients with coronavirus disease 2019 and acute coronary syndrome is still uncertain. We describe the percutaneous treatment of an unprotected left main coronary artery in a patient who is positive for coronavirus disease 2019 with unstable angina, dyspnea and fever. Particular attention will be dedicated to the measures adopted in the catheterization laboratory to protect the staff and to avoid further spread of the infection. (Level of Difficulty: Intermediate.) A 70-years-old gentleman with unstable angina was transferred to our center with persistent chest pain despite maximum antianginals. On admission, his blood pressure was 100/65 mm Hg, heart rate 72 beats/min and respiratory rate 14 breaths/min. Physical examination revealed normal vital signs, regular heart rhythm with no significant murmurs, and some bibasilar lung rales. He was referred to our hospital after presenting to a hospital in Bergamo and having angiographic evidence of chronic total occlusion of the right coronary artery (Video 1) and critical stenosis of distal left main coronary artery (LMCA) involving the ostia of both left anterior descending and left circumflex arteries (Videos 2 and 3). After the diagnostic angiogram, he was started on aspirin 100 mg and atorvastatin 80 mg once a day. From his blood tests, initial highsensitivity troponin I was 11 ng/l (normal Cardiovascular diseases significantly increase mortality in infected patients. Heart team discussion is key in decision making in this subset of patient. Personal protection protocols are fundamental to reduce the risk of infection in health care workers. Aside from previous bladder cancer, the patient denied any past cardiac events or cardiac risk factors. He was not on any medication prior to the diagnostic angiogram. After the heart team's discussion, it was decided to refer the patient to surgical revascularization within the 2 following days. However, after a few hours, the patient developed cough and fever (>39 C). Urgent chest x-rays demonstrated interstitial involvement of the lungs, which is suggestive for severe acute respiratory syndrome coronavirus 2 infection ( Figure 2 ). (Figures 3 and 4, Video 4) . The double kissing-crush technique has been widely described elsewhere (2) . After the procedure, the Impella CP catheter was removed without complications, and the femoral access was closed with the use of 2 Proglide closure systems (Abbott Vascular, Santa Clara, California). The staff allowed to enter the catheterization lab in oncologic patients (7) . Given the high number of infected patients, we often diagnose cardiovascular diseases at different stages during the viral pathology. In this perspective, some selected patients could benefit from treatments that deviate from current guidelines. We report the first case of a patient with COVID-19 and acute coronary syndromes treated in Italy for unprotected LMCA stenosis with protected percutaneous coronary intervention. The use of the Impella CP cardiac assist system to provide left ventricular support during high-risk percutaneous coronary interventions is recommended in such settings, because its efficacy is supported by randomized- @LBettari. ESC/EACTS guidelines on myocardial revascularization Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club Accessed. Q10 4. European Centre for Disease Prevention and Control. 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