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EmergentPCIinAMIPatients
withtransradialapproach
—StrategyandSkillsWeiminLi,MDTheFirstAffiliatedHospitalHarbinMedicalUniversity,Harbin,China
IntroductionAtthebeginning,TRAtendedtobeavoidedinAMIpatients.Majorconcernwasanexpectedlongertimeforarterialcannulation.Manystudieshavenowdemonstratedthesafety,feasibilityandgoodoutcomesofprimaryPCIperformedwithTRA,andwithadrasticreductioninvascularcomplicationsandlengthofin-hospitalstays.
Accordingtothemostrecentguidelines,patientswithTFAundergoaggressiveanticoagulation,whichleadseventuallytoanincreasedincidenceofbleeding(upto7%).However,thecombinationofGPIIb/IIIainhibitorsandcatheterisationwithTRAisvirtuallyavoidfromseriousbleeding.Introduction
Louvardetal.inthefirst50cases,demonstratedthatanyoperatorwillhaveafailureofabout10%,whichwilldropto3-4%afterother500cases,howeverproceduralfailurewillstabiliseafter1000proceduresatlessthan1%.Aoperatorwhoperformed500casesmayberegardedastheexperiencedoperatorforemergentTRAPCI.Indeed,TRAmayfinditsmostsuitableapplicationinpatientswithACS/STEMI.Introduction
A47-year-oldmaleSeverechestpainfor3hoursAhistoryofhypertension,hyperlipidemiaECG:precordialleadsshowingupto3mmSTelevationinleadsV1–V4Case1Theincidenceofslowflowandno-reflowafterPrimaryPCIisupto10%-20%,especiallyhighinlesionswithlargethrombusburden
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Case1OMthrombusaspiration
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Ifaspiratethethrombusfirst,theresultmaybebetter.
A72-year-oldmaleSeverechestpainfor3hoursTri-chamberpacemakerimplantationtwoyearsagoECG:ST-segmentelevationinleadsII,III,aVFDirectstentingstrategyisfeasibleinmostofemergentPCIcasesaf
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