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    <Journal>
      <PublisherName>jmedicalcasereports</PublisherName>
      <JournalTitle>Frontiers in Medical Case Reports</JournalTitle>
      <PISSN>I</PISSN>
      <EISSN>S</EISSN>
      <Volume-Issue>Volume 2; Issue 1</Volume-Issue>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <Season>(Jan-Feb, 2021)</Season>
      <SpecialIssue>N</SpecialIssue>
      <SupplementaryIssue>N</SupplementaryIssue>
      <IssueOA>Y</IssueOA>
      <PubDate>
        <Year>-0001</Year>
        <Month>11</Month>
        <Day>30</Day>
      </PubDate>
      <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>
      <SubTitle/>
      <ArticleLanguage>English</ArticleLanguage>
      <ArticleOA>Y</ArticleOA>
      <FirstPage>1</FirstPage>
      <LastPage>8</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Juliana</FirstName>
          <LastName>Senftinger</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Peter</FirstName>
          <LastName>Clemmensen</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Stefan</FirstName>
          <LastName>Blankenberg</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
          <FirstName>Christina</FirstName>
          <LastName>Magnussen</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>Y</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI/>
      <Abstract>There is still conflicting evidence concerning the optimal therapeutic approach during cardiogenic shock in patients with acute myocardial infarction.&#13;
&#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;
&#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>
      <AbstractLanguage>English</AbstractLanguage>
      <Keywords>Acute Coronary Syndrome,Chronic Total Occlusion,Cardiogenic Shock,Mechanical Circulatory Support,Case Report</Keywords>
      <URLs>
        <Abstract>https://www.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>
      </URLs>
      <References>
        <ReferencesarticleTitle>References</ReferencesarticleTitle>
        <ReferencesfirstPage>16</ReferencesfirstPage>
        <ReferenceslastPage>19</ReferenceslastPage>
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      </References>
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