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Case Reports
. 2025 Jun 7:2025:3481920.
doi: 10.1155/cric/3481920. eCollection 2025.

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

Anne Sandstrom  1 , Kristen Errico  1 , Debanshu Roy  2 , Andrea J Carpenter  1 , Anand Prasad  2
Affiliations
Case Reports

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

Anne Sandstrom et al. Case Rep Cardiol. .

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) ECG demonstrating ST segment elevation involving the anterior precordial and inferior leads. (B) Coronary angiogram with 100% proximal LAD occlusion (arrowhead). (C) Post PCI angiogram following revascularization of the LAD (arrowheads). (D) LV apical thrombus (arrow). (E) Epicardial thrombus secondary to LV apical wall rupture (arrowhead), LV apical thrombus in close proximity to Impella catheter (arrow).
Figure 2
Figure 2
Illustration of the Sentinel device depicting the dual filters separated by an articulating sheath enabling placement into the innominate and left carotid arteries for cerebral embolic protection.
Figure 3
Figure 3
(A) Sentinel device; right brachiocephalic and left common carotid filters (arrowheads). (B) Impella catheter withdrawn into the subclavian artery during removal with Sentinel device in place (arrowhead). (C) An embolic particle captured during Impella removal. (D) Sentinel filter post Impella removal.
Figure 4
Figure 4
Proposed treatment strategy for patients with LV thrombus requiring Impella support.
See this image and copyright information in PMC

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