Use of the PulseCath iVAC 2L mechanical circulatory support device during left main coronary artery stenting: a clinical case report

Protected percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) remains a technically challenging procedure associated with a high risk of hemodynamic instability during balloon occlusion, particularly in patients with multivessel coronary artery disease and reduced left ventricular function. The use of mechanical circulatory support (MCS) devices enhances the safety of such interventions in high-risk patients. Among available platforms, the PulseCath iVAC 2L is a pulsatile transaortic left ventricular pump compatible with standard intra-aortic balloon pump consoles, providing active ventricular unloading while maintaining physiological pulsatile systemic perfusion [1, 2]. This article presents a clinical case of protected LMCA stenting using the iVAC 2L device in a 64-year-old female patient with nonQ anterior wall myocardial infarction and complex multivessel coronary artery disease, including critical stenosis of the distal LMCA with involvement of the left anterior descending (LAD) and left circumflex (LCx) artery ostia. Over the patient’s categorical refusal of coronary artery bypass grafting, a protected PCI strategy under mechanical hemodynamic support was selected. The iVAC 2L device was deployed via the right common femoral artery for 40 minutes in ECG-synchronized mode, while coronary access was obtained via the right radial artery. Following sequential predilatation, a 3.0×34 mm stent was implanted in the distal LMCA/proximal LAD segment using proximal optimization technique (POT) within a provisional stenting strategy. An optimal angiographic result was achieved, demonstrating TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow, no residual stenosis, and no intraprocedural complications. The patient was discharged on day 14 in satisfactory condition on dual antiplatelet therapy. This case demonstrates the feasibility and safety of using the iVAC 2L for LMCA stenting as a revascularization option in high-risk patients.

1. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Baumbach A, Bongiovanni C, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. DOI: https://doi.org/10.1093/eurheartj/ehy394

2. Chieffo A, Dudek D, Hassager C, Gooley R, Lang I, Mayr A, et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. Eur Heart J Acute Cardiovasc Care. 2021;10(5):570-583. DOI: https://doi.org/10.1093/ehjacc/zuab015

3. Bulum J, Bastos MB, Hlinomaz O, Pagnotta P, Stojkovic S, Den Uil CA, et al. Pulsatile Left Ventricular Assistance in High-Risk Percutaneous Coronary Interventions: Short-Term Outcomes. J Clin Med. 2024;13(18):5357. DOI: https://doi.org/10.3390/jcm13185357

4. den Uil CA, Daemen J, Lenzen M, Oei B, van Domburg RT, Serruys PW, et al. Pulsatile iVAC 2L circulatory support in high-risk percutaneous coronary intervention. EuroIntervention. 2017;12(14):1689-1696. DOI: https://doi.org/10.4244/EIJ-D-16-00481

5. Avetisyan EA, Dorogun OB, Krasnoperova EV, Gerasimov AN, Petrov AS, Ivanov VV, et al. Temporary mechanical circulatory support with the transaortic pulsatile-flow device iVAC 2L in high-risk percutaneous coronary intervention: a multicenter experience. Russian Cardiology Journal. 2025;30(1):5856. [date of access 2026 Apr 24]. Available from: https://russjcardiol.elpub.ru/jour/article/view/5856 (In Russ.).

6. PulseCath. iVAC 2L Post-Market Surveillance Registry Report [Электронный ресурс]. 2022. [дата обращения 2026 апр 24]. Режим доступа: https://www.pulsecath.com/wp-content/uploads/2022/12/PMS_report_marketing_R1058-1-2022.pdf

7. Bastos MB, Van Wiechen MP, Van Mieghem NM. PulseCath iVAC2L: next-generation pulsatile mechanical circulatory support. Future Cardiol. 2020;16(2):103-112. DOI: https://doi.org/10.2217/fca-2019-0060

8. Samol A, Wiemer M, Kaese S. Comparison of a pulsatile and a continuous flow left ventricular assist device in high-risk PCI. Int J Cardiol. 2022;360:7-12. DOI: https://doi.org/10.1016/j.ijcard.2022.05.038