Case submitted by Brian Kolski, MD, St. Joseph Hospital

Summary: 85-year-old woman with critical aortic stenosis and severe rest pain. Not a surgical candidate due to lung disease. Calcified near-occlusion of distal aorta and no transcaval or subclavian access option available. 7.0 mm x 60 mm Shockwave IVL delivered to bilateral iliac arteries. Post-IVL safe passage of a 26 mm Medtronic Evolut R TAVR/TAVI device followed by endovascular femoral repair. Patient discharged the following day.