Single-Access Technique for Impella-Assisted Balloon Aortic Valvuloplasty and High-Risk PCI in Cardiogenic Shock

The single-access technique for Impella-assisted high-risk percutaneous coronary intervention has been previously described and is frequently used in clinical practice to avoid a secondary arterial access and potentially reduce the risk of bleeding and vascular complications. Aortic stenosis associated with cardiogenic shock is associated with high morbidity and mortality. In this setting, Impella-supported balloon aortic valvuloplasty has been reported to be feasible and safe. In this case, we describe a technique for single-access Impella, balloon aortic valvuloplasty, and high-risk percutaneous coronary intervention for left main coronary artery disease in a patient with severe aortic stenosis and large body habitus presenting in cardiogenic shock.