急性冠脉综合征IVUS能为我们做些什么？

1、急性冠脉综合征IVUS能为我们做些什么？Mt. St. Helens, WA, USAPLAQUE RUPTURE 60-80% PLAQUE EROSION 20-40%CALCIFIED NODULE 2-7 %殊路异归殊路异归IVUS克服了血管造影的局限克服了血管造影的局限危险因素危险因素高血压高脂血症Diagnostic examination ECG :STEMI 前壁心肌酶 基线特征基线特征74 岁女性症状症状急性胸痛 1小时2 月前月前 : LM: 轻度管壁不规则轻度管壁不规则RCA: 轻度管壁不规则轻度管壁不规则LCX: LCX 近段弥漫性轻度病变近段弥漫性轻度病变LAD: L

2、AD 近中段近中段20% stenoses ; D1 开口开口70-80% stenosis Xience V DESLVG: 室壁运动正常室壁运动正常; EF=60%. Case 2 斑块分布在边支对面 边支闭塞可能较小基线特征基线特征 58 岁女性岁女性症状症状 急性胸痛急性胸痛 2 天天实验室检查实验室检查 TNI 15.35 ng/ml CK 1407 IU/L BNP 234.00 pg/ml 危险因素危险因素 无无ECG at Admission patient was asymptomatic and haemodynamically stable.CORDIS 6F JL3.5

3、 ，RUNTHROUGH wire， RYUJIN PLUS 2.5*15Angiogram (2013.3.28)Thrombus aspiration at LAD (Thrombuster Catheter) followed by tirofiban intra-coronary injection.Angiogram (2013.3.28)After Thrombus aspiration + tirofiban administration, vessel opened but sudden cardiopulmonary arrest occurred!After CPR wit

4、hin 20min, the patients spontaneous circulation & breath returned.IVUS examinationIVUS examination: No plaque at all, only Separation of the layers of the arterial wall was shown Angiogram (2013.3.28)Stent 3.5*32mm to LM/LADAngiogram (2013.3.28)Followed-up: Angiogram (2013.10.10)Followed-up : An

5、giogram (2013.10.10)Followed-up: Angiogram (2013.10.10)Followed-up: IVUS examination (2013.10.10)Case 1：Patient InformationRisk factors NoDiagnostic examination ECG : aVR Cardiac enzyme levels Baseline28 year-old FemaleSymptomsChest pressure for 3 Days ECG : aVR 压力压力Down 当导管碰到左主干口！当导管碰到左主干口！压力压力Down

6、 钓鱼技术钓鱼技术球囊预扩张后弹性回缩！球囊预扩张后弹性回缩！开口部位的冠脉壁组织与其它节段有所不同开口部位的冠脉壁组织与其它节段有所不同 -胶原和弹力纤维成分大胶原和弹力纤维成分大 -有血管负性重构的因素有血管负性重构的因素尤其是位于尤其是位于“冠脉树冠脉树”根部的根部的LMCutting balloon + Promus E stent 4.0*12MM to LMCCU检查检查UCG梅毒性冠脉病变特点：梅毒性冠脉病变特点：树胶样肿树胶样肿仅累及开口，仅累及开口，“鸟嘴样鸟嘴样”改变改变慢性侧枝循环开放慢性侧枝循环开放合并主动脉瓣病变合并主动脉瓣病变FL at 1 yearCase 1 I

7、VUS-LSG Radial Acess, TIG: pLAD CTO, mLCX 30% lesion mRCA CTOSVG-LAD: patencyTotally occluded SVG to RCA JR/ SAL /3DRC & AL failed, then MPA GC was chosen THROMBUS II could not get thoughTirofiban intracoronary from THROMBUS II THROMBUS II *4Thrombosis in native vessel vs. SVGSTENT 3.0*28, 3.5*1

8、5DistalProxMLAMt. St. Helens, WA, USABaseline男性，男性，71岁岁Symptoms间断性胸痛间断性胸痛3月，加重月，加重1wRisk factors DM病史病史HBP病史病史Diagnostic examination ECG：胸前导联：胸前导联V1-5ST段压低段压低心肌酶心肌酶: （）（）Attenuated Plaque1mmABCDABCDIVUS: AP (deep)IVUS: AP (superficial) IVUS: AP (superficial) IVUS: AP (deep)1mm1mm1mm1mmLPEarly NCLate

9、 NCLate NCHow iMAP Looks like?ACS Patient without No-refolwAttenuated plaque is an IVUS finding that indicated the presence of large lipid/necrotic core Associated with no-reflow in patients with coronary artery disease undercgoing PCI Patient InformationBaseline 58 year-old Male Acute chest pain for 4 hrs TNI CK EKG II