Thom Dahle, MD, and Brian Stegman, MD, perform this live percutaneous axillary Impella®-supported high-risk PCI case at St. Cloud Hospital, in Minnesota. The patient is a 71-year-old male with end-stage renal disease, severe PAD, CAD, previous MI, several PCIs, prior TAVR and multiple cardiovascular risk factors. The case highlights alternative access, contrast-sparing imaging, stent strategy discussions and bifurcation PCI. Seth Bilazarian, MD, with panelists John Lasala, MD, Raj Patel, MD, and Tim Smith, MD, provide commentary. “This was a great use of Impella,” Dr. Patel emphasizes, “in a patient at high risk for contrast-induced nephropathy.”