<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2d1 20170631//EN" "JATS-journalpublishing1.dtd">
      <JournalTitle>Frontiers in Medical Case Reports</JournalTitle>
      <Volume-Issue>Volume 2; Issue 1</Volume-Issue>
      <Season>(Jan-Feb, 2021)</Season>
      <ArticleType>Medical Case Reports</ArticleType>
      <ArticleTitle>High-Risk Coronary Revascularization in a Patient with Acute Myocardial Infarction - Culprit Lesion in Last Remaining Vessel - Case Report</ArticleTitle>
      <Abstract>There is still conflicting evidence concerning the optimal therapeutic approach during cardiogenic shock in patients with acute myocardial infarction.&#13;
We present a case of non-ST-segment elevation myocardial infarction with the RCA deemed culprit lesion due to absence of collaterals to the chronically occluded LAD and CFX. The 71-year-old patient presented to chest-pain-unit with angina pectoris Canadian Cardiovascular Society (CCS) grading III. Severe 2-vessel coronary artery disease was already diagnosed in 2014 with recommendation for coronary artery bypass grafting (CABG). However, the patient refused CABG at the time because of freedom from symptoms. Despite full revascularization by percutaneous coronary angioplasty (PCI) and mechanical circulatory support with Impella and extracorporeal membrane oxygenation, the patient died a few days later because of progressive hemodynamic decline and severe vascular complications.&#13;
While using mechanical circulatory support during cardiogenic shock, several complications especially vascular complications are to be expected. Therefore, we should aim to remove the Impella as soon as possible or if further needed consider switching it to central Impella. Furthermore, it remains questionable to what extent recanalization of chronic total occlusions (CTO) in cardiogenic shock impact patient outcomes.</Abstract>
      <Keywords>Acute Coronary Syndrome,Chronic Total Occlusion,Cardiogenic Shock,Mechanical Circulatory Support,Case Report</Keywords>
        <Abstract>https://jmedicalcasereports.org/ubijournal-v1copy/journals/abstract.php?article_id=9302&amp;title=High-Risk Coronary Revascularization in a Patient with Acute Myocardial Infarction - Culprit Lesion in Last Remaining Vessel - Case Report</Abstract>
        <References>Abaunza M, Kabbani LS, Nypaver T, Greenbaum A, Balraj P, Qureshi S, Alqarqaz MA, Shepard AD. Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device. J Vasc Surg 2015; 62: 417-423.&#13;
ABIOMED | Impella® Available at: http://www.abiomed.com/impella [Accessed October 18, 2019].&#13;
Boll G, Fischer A, Kapur NK, Salehi P. Right Axillary Artery Conduit Is a Safe and Reliable Access for Implantation of Impella 5.0 Microaxial Pump. Ann Vasc Surg 2019; 54: 54-59.&#13;
Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum and;Aacute;, Goodman SG, Flather MD, Anderson FA, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006; 333: 1091.&#13;
Hoebers LP, Claessen BE, Elias J, Dangas GD, Mehran R, Henriques JP. Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol 2015; 187: 90-96.&#13;
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen S, Hindricks G. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018; 39: 119-177.&#13;
Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis: A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699-1705.&#13;
Mathur M, Hira RS, Smith BM, Lombardi WL, McCabe JM. Fully Percutaneous Technique for Transaxillary Implantation of the Impella CP. JACC Cardiovasc Interv 2016; 9: 1196-1198.&#13;
Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial No-Reflow in Humans. J Am Coll Cardiol 2009; 54: 281-292.&#13;
Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, Vis MM, Wykrzykowska JJ, Koch KT, Baan J, de Winter RJ. Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2017; 69: 278-287.&#13;
Pappalardo F, Schulte C, Pieri M, Schrage B, Contri R, Soeffker G, Greco T, Lembo R, Mand;uuml;llerleile K, Colombo A, Sydow K. Concomitant implantation of Impella ® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail 2017; 19: 404-412.&#13;
Scarpone M, Cenko E, Manfrini O. Coronary No-Reflow Phenomenon in Clinical Practice. Curr Pharm Des 2018; 24: 2927-2933.&#13;
Schrage B and Westermann D. Mechanical circulatory support devices in cardiogenic shock and acute heart failure. Curr Opin Crit Care 2019; 25, 391-396.&#13;
Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, Eitel I, Nordbeck P, Geisler T, Landmesser U, Skurk C (2018). One-year outcomes after PCI strategies in cardiogenic shock. N Engl J Med 379: 1699-1710.&#13;
Thiele H, Akin I, Sandri M, Fuernau G, de Waha S, Meyer-Saraei R, Nordbeck P, Geisler T, Landmesser U, Skurk C, Fach A. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 2017; 377: 419-2432.</References>