左冠脉主干病变急诊行经皮冠脉介入治疗

EmergentPCIforLMDisease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）1/16/20251

GeneralSituation

YuanXX,male75yrs;

Hypertensionfor20yrs,NIDDMfor10yrs;

2yrsago,had2DESinLAD(nodetail)

Severechestpain,withheavysweatonMarch22,20088:30am.WithV2-V6STsegmentelevation.

About10:20am,theemergentcoronaryangiogramwasdone.

HR:89/min,BP:110/75mmHg,PO2:98%

1/16/202521/16/202531/16/202541/16/20255What’stheStrategy,next?

PCIoremergentCABG

?1PCI,what’sthestrategyforthiscriticallesion?DoCXfirst,ortouchLADfirst?2DoesthissituationneedIABPsupportorno?3putDESorBMS,asthepatienthad2DESinLAD?Tstent,provisional-Tcrushorbeselect?4WefullydilatedallsegmentofoldDESorjustmakeitTIMI-3flow?1/16/20256Whatwehaddone?

EmergentPCIwithIABPsupport1IABPfirst,eventhehemodynamiclooksstable;27FEBU3.5,wireLADandCXwithBMW;3InflatetheCXhighseverelesionfirst,with2.5-15mmworld-passballoon,thenextractingtheoccludedLADwithDiverCE;theninflatetheLADfromstenttotheostiumwith2.5-15;PutEndeavor3.5-18andFirebird3.0-23stentfromLMtomid-CXwith18atm;Re-crosswireintoLAD,inflatestent,thenputanotherEXCEL3.0-14mmstentwith16atm;finalkissingwithtwostentballoon.

ProvisionalTstent

1/16/202571/16/202581/16/20259Amorning3dayslater

1/16/202510What’stheprobleminthisre-occluded:

1StentinLADostiumwasunder-expension?2Stents/thrombusindistalofLADwasnotinflatedfir