左冠脉主干病变急诊行经皮冠脉介入治疗.ppt

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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）8/6/20211GeneralSituationYuanXX,male75yrs;Hypertensionfor20yrs,NIDDMfor10yrs;2yrsago,had2DESinLAD(nodetail)Severechestpain,withheavysweatonMarch22,20088:30am.WithV2-V6STsegmentelevation.About10:20am,thee

2、mergentcoronaryangiogramwasdone.HR:89/min,BP:110/75mmHg,PO2:98%8/6/202128/6/202138/6/202148/6/20215What’stheStrategy,next?PCIoremergentCABG?1PCI,what’sthestrategyforthiscriticallesion?DoCXfirst,ortouchLADfirst?2DoesthissituationneedIABPsupportorno?3putDESorBMS,asthepatienthad2D

3、ESinLAD?Tstent,provisional-Tcrushorbeselect?4WefullydilatedallsegmentofoldDESorjustmakeitTIMI-3flow?8/6/20216Whatwehaddone?EmergentPCIwithIABPsupport1IABPfirst,eventhehemodynamiclooksstable;27FEBU3.5,wireLADandCXwithBMW;3InflatetheCXhighseverelesionfirst,with2.5-15mmworld-pass

4、balloon,thenextractingtheoccludedLADwithDiverCE;theninflatetheLADfromstenttotheostiumwith2.5-15;PutEndeavor3.5-18andFirebird3.0-23stentfromLMtomid-CXwith18atm;Re-crosswireintoLAD,inflatestent,thenputanotherEXCEL3.0-14mmstentwith16atm;finalkissingwithtwostentballoon.ProvisionalT

5、stent8/6/202178/6/202188/6/20219Amorning3dayslater8/6/202110What’stheprobleminthisre-occluded:1StentinLADostiumwasunder-expension?2Stents/thrombusindistalofLADwasnotinflatedfirsttime?3otherproblems?8/6/202111谢谢8/6/202112