Key result
Subclavian VA-ECMO facilitates successful TAVR and complex PCI, enabling weaning in cardiogenic shock.
Why the study?
Severe aortic stenosis and critical coronary disease can coexist in cardiogenic shock, requiring individualized decisions regarding access, sequencing, and antithrombotic therapy.
Case Report (n=1)
This case demonstrates the feasibility of individualized access planning using subclavian VA-ECMO to allow transfemoral TAVR followed by complex PCI in patients with cardiogenic shock and severe coexisting coronary, valvular, and peripheral disease.
Hypothesis-generating for subclavian VA-ECMO in combined TAVR/PCI with shock; prospective validation required before adoption.
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.
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Fukamachi et al. (2026) conducted a case report in Cardiogenic shock with severe aortic stenosis and critical coronary disease (n=1). Subclavian VA-ECMO-supported TAVR and rotational atherectomy-assisted PCI was evaluated. Subclavian VA-ECMO facilitated TAVR and subsequent left radial rotational atherectomy-assisted PCI, allowing for safe VA-ECMO weaning in a patient with cardiogenic shock.
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