Awake extracorporeal membrane oxygenation for very high-risk coronary angioplasty.

High-risk angioplasty has been defined as an intervention on an unprotected left main (LM) coronary artery or "last patent coronary conduit" in the context of moderate to severe left ventricular (LV) dysfunction. We report a case of a patient with severe LV dysfunction, severe aortic valve stenosis, and an occluded right coronary artery requiring elective intervention on a heavily calcified subtotally occluded LM coronary artery while the patient was awake with extracorporeal membrane oxygenation (ECMO) support. Given the added benefit of percutaneous closure, we believe that ECMO support with only conscious sedation is a viable mode of hemodynamic support in high-risk cases.