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We report a successful antegrade recanalization of a 67-year-old male who survived cardiopulmonary resuscitation after a non-ST elevation acute myocardial infarction. The patient experienced cardiac arrest due to ventricular fibrillation after admission in hospital and he was stabilized after 25 min of cardiopulmonary resuscitation. After resuscitation no neurological symptoms were detected. Coronary angiography revealed in chronic total occlusions (CTO) three-vessels with severe coronary calcifications (Panels Dand E); the patient was not considered to be a surgical candidate due to his poor clinical condition [very low ejection fraction (EF) <20% and acute coronary syndrome (ACS) at presentation] and for his angiographic characteristics (very small coronary arteries without visualization of distal coronary segments). Extracorporeal membrane oxygenation (ECMO) (PanelAC show ECMO for circulatory failing heart system in real clinical patient setting after epidural anesthesiology and femoral vein and artery surgical cannulation; the pump maintain a minimum flow of 2.0 L/min) and percutaneous coronary intervention (PCI) by the use of new composite dual coil guidewire Fielder XTR (Asahi Intecc Co, Japan) 48-hours after AMI, was used to fully recanalized left anterior descending artery (LAD), circumflex artery (CX) and right coronary artery (RCA). Excellent angiographic results were obtained by the use of three, two and four drug eluting stent (DES) in the LAD, CX, and RCA respectively (Panels F and G), and ECMO was terminated at the end of the procedure.

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