急性心梗患者急诊经桡动脉行PCI—策略和技巧(英文版）.ppt

Emergent PCI in AMI Patientswith transradial approach—Strategy and Skills Weimin Li, MD Introduction At the beginning,TRA tended to be avoided in AMI patients. Major concern was anexpected longer time for arterial cannulation . Many studies have now demonstrated the safety, feasibility and good outcomes of primary PCI performed with TRA,and with a drastic reduction in vascular complications and length of in-hospital stays. Introduction According to the most recent guidelines, patients with TFA undergo aggressive anticoagulation, which leads eventually to an increased incidence of bleeding(up to 7%). However, the combination of GP IIb/IIIa inhibitors and catheterisation withTRA is virtually avoid from serious bleeding. Introduction Louvard et al. in the first 50 cases, demonstrated that any operator will have a failure of about 10%, which will drop to 3-4% after other 500 cases, however procedural failure will stabilise after 1000 procedures at less than 1%. A operator who performed 500 cases may be regarded as the experienced operator for emergent TRA PCI. Indeed,TRA may find its most suitable application in patients with ACS/ STEMI. A 47-year-old male Severe chest pain for 3 hours A history of hypertension, hyperlipidemia ECG: precordial leads showing up to 3 mm ST elevation in leads V1–V4 Case 1 Case 1 Case 1 Case 1 Case 1 Case 1 Case 1 Case 1 If aspirate the thrombus first, the result maybe better. A 72-year-old male Severe chest pain for 3 hours Tri-chamber pacemaker implantation two years ago ECG: ST-segment elevation in leads II, III, aVF Case 2 Case 2 Case 2 TAPAS In the thrombus-aspiration group, direct stent implantation were performed in 55.1% cases. In the conventional- PCI group, 98.8% cases need balloon predilation. It has been reported that more than half of the culprit lesions(66%) in AMI patients with stenosis 50% and in major