Subclavian VA-ECMO-Supported TAVR and Rotational Atherectomy in Cardiogenic Shock.

BACKGROUND: Severe aortic stenosis and critical coronary disease can coexist in cardiogenic shock, requiring individualized decisions regarding access, sequencing, and antithrombotic therapy. CASE SUMMARY: A 72-year-old man with prior coronary artery bypass grafting developed progressive low-output heart failure with low-flow, low-gradient severe aortic stenosis and critical calcified native left anterior descending artery disease after left internal thoracic artery graft occlusion. Right common iliac artery occlusion limited conventional femoral arterial support. Subclavian venoarterial extracorporeal membrane oxygenation preserved left transfemoral access for transcatheter aortic valve replacement, which was followed by left radial rotational atherectomy-assisted left anterior descending percutaneous coronary intervention. DISCUSSION: This case illustrates individualized access planning and transcatheter aortic valve replacement-first sequencing to facilitate protected complex percutaneous coronary intervention and safe venoarterial extracorporeal membrane oxygenation weaning in cardiogenic shock.