The volume of complex coronary interventions has grown in Brazil and worldwide. Since they are performed in patients at increasingly higher risks, new techniques have been developed when interventional cardiologists are faced with uncommon situations, such as no safe arterial access for the procedure. We report a case of a patient with severe peripheral artery disease and occluded right femoral artery, in whom a single access (left femoral artery) was used for positioning the Impella™ and the guidewire for angioplasty.