左冠脉主干病变急诊行经皮冠脉介入治疗文档资料.ppt

2023/4/27,1,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.With V2-V6 ST segment elevation.About 10:20 am,the emergent coronary angiogram was done.HR:89/min,BP:110/75mmHg,PO2:98%,2023/4/27,2,2023/4/27,3,2023/4/27,4,2023/4/27,5,Whats the Strategy,next?PCI or emergent CABG?,1 PCI,whats the strategy for this critical lesion?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?,2023/4/27,6,What we had done?Emergent PCI with IABP 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 3.5-18 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,2023/4/27,7,2023/4/27,8,2023/4/27,9,A morning 3 days later,2023/4/27,10,Whats the problem in this re-occluded:,1 Stent in LAD ostium was under-expension?2 Stents/thrombus in distal of LAD was not inflated first time?3 other problems?,2023/4/27,11,谢 谢,