左冠脉主干病变急诊行经皮冠脉介入治疗

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1、EmergentPCIforLMDisease解放军总医院全军心血管病研究所心血管病中心心血管内科王禹王峙峰（北京复兴路28号，100853）7/15/20211GeneralSituationYuanXX,male75yrs;Hypertensionfor20yrs,NIDDMfor10yrs;2yrsago,had2DESinLAD(nodetail)Severechestpain,withheavysweatonMarch22,20088:30am.WithV2-V6STsegmentelevation

2、.About10:20am,theemergentcoronaryangiogramwasdone.HR:89/min,BP:110/75mmHg,PO2:98%7/15/202127/15/202137/15/202147/15/20215What’stheStrategy,next?PCIoremergentCABG?1PCI,what’sthestrategyforthiscriticallesion?DoCXfirst,ortouchLADfirst?2DoesthissituationneedIABPs

3、upportorno?3putDESorBMS,asthepatienthad2DESinLAD?Tstent,provisional-Tcrushorbeselect?4WefullydilatedallsegmentofoldDESorjustmakeitTIMI-3flow?7/15/20216Whatwehaddone?EmergentPCIwithIABPsupport1IABPfirst,eventhehemodynamiclooksstable;27FEBU3.5,wireLADandCXwithB

4、MW;3InflatetheCXhighseverelesionfirst,with2.5-15mmworld-passballoon,thenextractingtheoccludedLADwithDiverCE;theninflatetheLADfromstenttotheostiumwith2.5-15;PutEndeavor3.5-18andFirebird3.0-23stentfromLMtomid-CXwith18atm;Re-crosswireintoLAD,inflatestent,thenputa

5、notherEXCEL3.0-14mmstentwith16atm;finalkissingwithtwostentballoon.ProvisionalTstent7/15/202177/15/202187/15/20219Amorning3dayslater7/15/202110What’stheprobleminthisre-occluded:1StentinLADostiumwasunder-expension?2Stents/thrombusindistalofLADwasnotinflatedfirst

6、time?3otherproblems?7/15/202111谢谢7/15/202112