Usefulness and safety of trans-radial endovascular therapy for puncture-site bleeding in a patient with acute coronary syndrome requiring mechanical circulatory support.

UNLABELLED: A 66-year-old man with acute coronary syndrome underwent emergency percutaneous coronary intervention (PCI) using Impella CP (Abiomed, Danvers, MA, USA) via the left common femoral artery (CFA). After PCI, he experienced shock and severe anemia. A computed tomography scan revealed a large retroperitoneal hematoma caused by femoral puncture-site bleeding. He was in hemorrhage and cardiogenic shock, so we needed to achieve hemostasis without removing Impella CP. We performed endovascular therapy (EVT) through the radial artery system. Angiography showed ongoing bleeding in the left CFA. Initially, we attempted balloon tamponade with an 8-mm semi-compliant balloon, but this was unsuccessful. We then performed percutaneous thrombin injections combined with balloon tamponade. Ultimately, we achieved hemostasis at the puncture site. Our case suggests that trans-radial EVT combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding. LEARNING OBJECTIVE: Trans-radial endovascular therapy combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding, even in patients requiring mechanical circulatory support.