左冠脉主干病变急诊行经皮冠脉介入治疗.ppt

Emergent PCI for LM Disease 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） General SituationYuan XX, male 75 yrs;Hypertension for 20 yrs, NIDDM for 10 yrs;2 yrs ago,had 2 DES in LAD (no detail) Severe chest pain, with heavy sweat on March 22,2008 8:30 am. With V2-V6 ST segment elevation.About 10:20 am, the emergent coronary angiogram was done.  HR: 89/min, BP: 110/75mmHg,PO2: 98% What’s the Strategy, next?PCI or emergent CABG ? 1 PCI, what’s the strategy for this critical lesion? Do CX first, or touch LAD first? 2 Does this situation need IABP support or no? 3 put DES or BMS, as the patient had 2 DES in LAD? T stent, provisional-T crush or be select? 4 We fully dilated all segment of old DES or just make it TIMI-3 flow? What we had done? Emergent PCI with IABP support 1 IABP first, even the hemodynamic looks stable; 2 7F EBU 3.5, wire LAD and CX with BMW; 3 Inflate the CX high severe lesion first, with 2.5-15mm world-pass balloon, then extracting the occluded LAD with Diver CE; then inflate the LAD from stent to the ostium with 2.5-15; Put Endeavor 3.5-18 and Firebird 3.0-23 stent from LM to mid-CX with 18atm; Re-cross wire into LAD, inflate stent, then put another EXCEL 3.0-14mm stent with 16 atm; final kissing with two stent balloon. Provisional T stent A morning 3 days later What’s the problem in this re-occluded: 1 Stent in LAD ostium was under-expension? 2 Stents/thrombus in distal of LAD was not inflated first time? 3 other problems? * * *