Prof. Florim Cuculi, MD, Adrian Attinger, MD, and Matthias Bossard, MD, perform this complex, high-risk PCI case in Luzern, Switzerland. The patient is a 58-year-old male with heart failure and low ejection fraction. Angiography revealed a proximal LAD CTO and subtotal occlusion of the proximal circumflex. The patient was randomized to the Impella® arm of the PROTECT IV randomized controlled trial. Prof. Cuculi emphasizes the merits of Impella support throughout this challenging case, stating that without Impella support “you might be quite reluctant to go the extra mile” in terms of intravascular imaging and use of other tools during the case.