Time	Event
Day 1	The patient was admitted to a peripheral hospital with NSTE-acute coronary syndrome presenting with sustained ventricular tachycardia (VT), which was initially treated with a single DC shock. Echocardiogram showed severely reduced systolic ventricular function
Day 2	He was transferred to our tertiary centre where coronary angiography showed a three-vessel coronary artery disease with chronic total occlusion of right coronary and left circumflex and diseased left anterior descending artery (LAD). The VT episode was linked to ischaemia of the last remaining vessel and revascularization deemed necessary. The case was discussed within the heart team and the patient was considered too high risk for surgery. A decision was made to perform PCI of last remaining vessel under Impella support
Day 3	Impella CP was inserted over the 14 Fr sheath in the right femoral artery after pre-closure with two Perclose. A single-access technique was attempted and a sheathless Power Backup 3.5 7.5 Fr guiding catheter was directly inserted over the 0.035″ guidewire, without friction and mechanical interference with the Impella catheter. Complex PCI to LAD was performed. The Impella device was removed and the arterial access closed percutaneously without complications
Day 4	The patient remained asymptomatic and was transferred to referring hospital