WHEN THE COMPLEX MEETS THE HIGH-RISK: MECHANICAL CARDIAC SUPPORT DEVICES AND PERCUTANEOUS CORONARY INTERVENTIONS IN SEVERE CORONARY ARTERY DISEASE

Abstract Coronary artery disease (CAD) remains a leading cause of mortality and morbidity worldwide. Few practice guidelines directly address the issue of revascularization in CAD patients at higher risk of periprocedural complications. It remains a challenge to appropriately identify the subset of CAD patients that will require short-term use of mechanical cardiocirculatory support devices (MCSD) when high risk (HR) percutaneous coronary interventions (PCI) is required. Issues of the complexity (coronary anatomy and high burden of co-morbidities) and risk status (hemodynamic precarity or compromise) need to be considered when considering revascularization in patients. This review will focus on the evolving concept of protected PCI in CAD patients, and how a balanced, integrated Heart Team approach remains the path to optimal patient-centered care in the setting of HR-PCI supported with MCSD.