This document discusses a case involving a 75-year-old man with heart failure who required percutaneous coronary intervention (PCI) and left ventricular support. The patient had multiple medical issues including hypertension, diabetes, and prior heart attack. He was evaluated at multiple hospitals and found to have severe left ventricular dysfunction. The document discusses the risks and benefits of different percutaneous support devices that were considered for the planned PCI, including intra-aortic balloon pump (IABP) and Impella. It summarizes data from clinical trials comparing outcomes of IABP versus Impella support. The document concludes that combining transradial PCI with femoral placement of an Impella device may optimize outcomes in high-risk patients by reducing bleeding risks while