左冠脉主干病变急诊行经皮冠脉介入治疗

1、12.04.2021,整理课件,1,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）,12.04.2021,整理课件,2,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

2、. With V2-V6 ST segment elevation.About 10:20 am, the emergent coronary angiogram was done. HR: 89/min, BP: 110/75mmHg,PO2: 98%,12.04.2021,整理课件,3,12.04.2021,整理课件,4,12.04.2021,整理课件,5,12.04.2021,整理课件,6,Whats the Strategy, next?PCI or emergent CABG ?,1 PCI, whats the strategy for this critical lesion?

3、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?,12.04.2021,整理课件,7,What we had done? Emergent PCI with I

4、ABP 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、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,12.04.2021,整理课件,8,12.04.2021,整理课件,9,12.04.2021,整理课件,10,A morning 3 days later,12.04.2021,整理课件,11,Whats the problem in this re-occluded:,1 Stent in LAD ostium was under-expension? 2 Stents/thrombus in