This patient underwent coronary angiography via the right femoral route. Left heart catheterization showed coronary arteries unchanged from a prior catheter angiogram in 2010 with chronic right coronary artery (RCA) total occlusion and a calcific moderate proximal LAD lesion that was found to be significant on intravascular ultrasound (IVUS). Rotablation was performed to the proximal LAD and a drug-eluting stent (DES) was placed into the proximal LAD. The procedure was done under Impella support that was placed via the left femoral access site (14 Fr sheath).

The Impella LVAD was placed before stenting the proximal LAD as the patient was felt to be a high risk given multiple other cardiac comorbidities.