Transbrachial intra-aortic balloon pump before urgent coronary artery bypass graft in a patient with severe peripheral atherosclerosis

A 76-year-old man, a current smoker with a long-standing history of diabetes, was admitted to our institution due to non-ST segment elevation acute coronary syndrome. He was haemodynamically unstable, with signs of pulmonary oedema and hypotension, so intravenous inotropes were initiated. A transradial angiogram showed severe three-vessel coronary artery disease involving the distal left main coronary artery (Figure 1a and b). A bedside echocardiogram displayed severe left ventricular dysfunction and grade IV mitral regurgitation. The patient presented severely calcified peripheral arteriopathy (Figure 1c) and both inferior limbs were pulseless. A left transbrachial approach was used under fluoroscopy guidance to implant