Bilateral Embolic Protection Devices for High-Risk Cardiac Surgery in a Patient With Recent Embolic Stroke
Cerebral embolic protection devices (EPDs) such as carotid filters were first introduced as an adjunct to carotid artery stenting out of concern for increased rates of procedure-related atheromatous plaque embolization compared with carotid endarterectomy. Here, we report the use of a carotid filter device for embolic protection during high-risk coronary artery bypass grafting and ventricular assist device explantation in a patient with a recent history of embolic cerebrovascular accident from severe aortic atherosclerosis.
A 67-year-old man with no known history of coronary artery disease presented to an outside hospital with acute shortness of breath. Initial chest x-ray demonstrated complete opacification of the lung spaces consistent with decompensated pulmonary edema. The ECG demonstrated pan-ST segment depressions with ST elevation in lead V1 and was concerning for severe left main coronary artery stenosis. He was transferred to Columbia University Medical Center in cardiogenic shock for emergent angiography and evaluation for coronary intervention.
At catheterization, left ventriculography showed an ejection fraction of 15% to 20% with global hypokinesis. Coronary angiography revealed a right dominant system with a thrombotic 90% stenosis of a trifurcating distal left main coronary artery (Figure [A]). The right coronary artery was occluded proximally and filled retrograde via the left circulation (Figure [B]). Despite initial …