title: Total revascularization for an epsilon right coronary artery and severe left main disease combined with profound cardiogenic shock: A case report.
abstract: BACKGROUND
  Severe left main disease combined with right coronary artery occlusion was rarely encountered in our daily practice. Percutaneous coronary intervention in these patients was most challenging due to high probability of hemodynamic changes.
  
  
  METHODS
  Here, we report a 67-year-old man with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) and profound cardiogenic shock and we attempted coronary intervention with total revisualization for severe left main (LM) disease and angulated epsilon right coronary artery total occlusion. He was treated successfully under intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) support.
  
  
  METHODS
  NSTEMI and profound cardiogenic shock.
  
  
  METHODS
  Coronary intervention with total revisualization was performed for severe LM disease and angulated epsilon right coronary artery total occlusion under IABP and ECMO support.
  
  
  RESULTS
  IABP and ECMO were removed until cardiac contractile function improved to left ventricular ejection fraction over 40 percentage 1 week later. The patient was discharged after 2 months and had survival for 5 years.
  
  
  CONCLUSIONS
  Coronary intervention could be performed safely in this cardiogenic shock patient with severe LM and triple vessel disease who was supported by IABP and ECMO. Stent deployment for extremely angulated coronary artery was required multiple combination techniques to facilitate the final success.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Lee
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D054059:Coronary Occlusion / Q000150:complications; D003331:Coronary Vessels / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D012770:Shock, Cardiogenic / Q000150:complications* / Q000601:surgery