A patient with ischemic cardiomyopathy (ejection fraction 19% and severe left ventricular dilation) was referred for PCI of left main CTO. An Impella CP device was placed prophylactically for hemodynamic support and a 7 French sheath was placed through the Impella sheath (Single-access for Hi-risk PCI- SHiP technique). The LAD was crossed using antegrade wire escalation and the circumflex using antegrade dissection and re-entry using a Stingray balloon. The left main was successfully stented using the DK crush technique with an excellent final result. The Impella was removed at the end of the procedure.
