A contemporary and complete treatment solution for a high-risk patient with critical aortic stenosis, left ventricular thrombus, severe left ventricular dysfunction, and calcified left main stem disease.

The combination of severe coronary disease, significant valvular dysfunction and impaired ventricular function pose patients at a very high procedural risk. In addition, the presence of left ventricular thrombus can complicate ventricular instrumentation increasing embolic risk. Contemporary techniques and devices have now become available to overcome these challenges to reduce risk and allow safer, more efficient procedures. We describe the feasibility of using Impella CP™ with cerebral protection to facilitate complete revascularisation and percutaneous valve replacement in a patient with critical aortic stenosis, severe left ventricular (LV) impairment, LV thrombus and a calcified left main stem disease.