The no-flow phenomenon following drug-coated balloon angioplasty in a patient with chronic limb-threatening ischemia and a history of below-knee amputation

The endovascular treatment using a drug-coated balloon (DCB) reduces restenosis and target vessel re-vascularization rate in patients with peripheral artery disease such as claudication and chronic limb-threatening ischemia (CLTI). However, its safety and efficacy in patients with post-below-knee amputation remain unknown. We had a patient with CLTI and a history of below-knee amputation, who suffered a no-flow phenomenon following DCB angioplasty that required above-knee amputation. DCB angioplasty might not be appropriate for those with severe CLTI and histories of amputation.

Learning objective

The present report describes the risk of endovascular treatment using a drug-coated balloon for chronic limb-threatening ischemia patients with a below-knee amputated limb.

Case series of transcatherter edge-to-edge repair using MitraClip™ system with Impella® mechanical circulatory support

BACKGROUND

Secondary mitral regurgitation (SMR) is a major comorbidity in patients with heart failure with reduced ejection fraction (HFrEF). Transcatheter edge-to-edge repair (TEER) using the MitraClip™ system is a promising tool for selected patients with SMR and HFrEF. Durable success using this system in patients who have advanced heart failure and unsuitable anatomy remains a clinical challenge.

CASE SUMMARY

Three patients aged 67-72 years with HFrEF on inotropic support successfully underwent Impella®-assisted TEER at our centre. Following the procedure, two patients were able to be weaned off inotropic support and were discharged, while one patient expired during the index hospitalization.

DISCUSSION

Impella®-assisted TEER may be a feasible strategy for patients with SMR and HFrEF with unstable haemodynamics particularly when cardiac replacement therapy is not applicable.