The intra-aortic balloon pump in high-risk percutaneous coronary intervention: is counterpulsation counterproductive?

摘要

The rapid increase in the number of percutaneous coronary interventions being performed has led to a corresponding rise in the complexity of lesions attempted and the extent of patient comorbidities permitted. In order to redress the balance in these high-risk subsets, interventionalists are furnished with ever-progressive pharmacotherapy and the continuing evolution of mechanical adjuncts, such as the intra-aortic balloon pump. Now some 40 years since its first-in-man description, the situations and strategies In which to utilize its attractive physiological properties are still open to debate, whilst its use in cardiogenic shock following acute infarction is incorporated into current US and European guidelines. The aim of this article is to track the development of diastolic augmentation from conception to class 1 recommendations based on registry and trial data, whilst offering a speculative view on the future use of counterpulsation in high-risk interventions with respect to an expanding percutaneous coronary assist device market.