Sukesh Burjonroppa, MD, FACC, FSCAI, discusses strategies for timing of percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) in patients requiring both procedures and provides two case studies. The first case study illustrates complex coronary, peripheral vascular and valvular pathology addressed in staged procedures. The second case illustrates post-TAVR coronary access for complex PCI in a patient with complex anatomy and emergent cardiogenic shock. “High-risk PCI with Impella® support in TAVR patients can be done with optimal outcomes in these patients,” Dr. Burjonroppa concludes, emphasizing the importance of a multidisciplinary team with interventionalists well-versed in structural, peripheral and coronary interventions.