Introduction: Patients with complex or high-risk coronary lesions, such as those with the critical stenosis of left main, multi-vessel coronary disease or last remaining vessel, are increasingly being treated with percutaneous coronary intervention (PCI). Periprocedural hemodynamic compromise and complications may occur rapidly so many of these high-risk procedures are being performed with some kind of mechanical circulatory support. Recently, an extracorporeal membranous oxygenation (ECMO) was suggested as a mechanical support for high risk PCI. (1, 2)

Case presentation: We present a case of a 76-year-old female who was hospitalized in Coronary Care Unit due to unstable angina. Echocardiography showed mildly reduced systolic function of left ventricle (LV) with akinesia of anterior wall of LV. Coronary angiogram revealed multivessel disease, with significant stenosis of left main, significant stenosis of ostial portion of left anterior descending artery, midportion of left circumflex artery (ACx), ostial, proximal and midportion of right coronary artery and bifurcational highly significant stenosis of ACx with the first obtuse marginal branch (MEDINA 0,1,1). The calculated Syntax score was 41. Cardiac surgeon denied operation due to advanced age of the patient and calcified aorta. Due to high-risk PCI, veno-arterial ECMO support was introduced and total coronary revascularization was done with an optimal final result. Pre-discharge echocardiography showed improved systolic function and two years’ follow-up is without any drawbacks (stable angina pectoris CCS 1).

Conclusion: ECMO mechanical support is a reasonable option for patients with a high-risk PCI. In our opinion it is of outmost importance to recognize the need for hemodynamic support on time in order to avoid periprocedural complications. Furthermore, it is important to have highly trained team in order to reduce possible ECMO related complications to the bare minimum.