急性心肌梗死左主干闭塞急诊PCI一例

急性心肌梗死左主干闭塞急诊PCI一例第1页/共16页HistoryFemale,53yrs.Chestpainfollowedbyunconsciousnessinashoppingcenternearourhospital3hrsago.NohistoryofHT,HL,DMorsmoking.CPRwithmechanicalventilationwasperformedinambulanceandemergencyroomECG:STsegmentelevationinleadsofI,avlandV1-6.Afterconsciousnessandspontaneouslybreathingwererecovered,mechanicalventilationwasremoved.第2页/共16页Emergencyangiographywasperformed:Stenosisof90%inLM,andstenosisof50%inostialLADandLCXNormalRCAwithoutcollateralflow第3页/共16页Q1:E-CABG?E-PCI?2stent?1stent?ProtectionwireinLCX?Inemergencysetting:“Thesimpler,thebetter”“1wire,1balloon,1stent”第4页/共16页GC:6FJL4.0(Laucher),GW:BMW,Balloon:2.5×15(Sprinter)第5页/共16页Cypherstentof3.5×23wasimplanted(18-22atm)第6页/共16页SignificantstenosisinostialLCX第7页/共16页Q2:POBAinLCX,finishedbykissingballoon?ProvisionalstentinLCX?Tstent?MiniCrush?第8页/共16页AftercrossedbyRunthroughwire,ostialLCXwaspre-dilatedbyballoonof2.0and2.5mm.Whileaballoonof3.5mm(Maverick)inLM,aCypherstentof3.0×18wasimplanted(14atm)withalittlesegmentextrudedintoLM第9页/共16页AftertheballonandwireinLCXwereremoved,theballoonof3.5inLMwasdilatedtocrushthestentinLCX第10页/共16页AfterrewiredbyRunthroughwire,thestentcellinostialLCXwasre-openedbyballoonof2.0mm第11页/共16页Finishedbykissingballooning(balloonof3.5mminLAD,whileballoonof3.0mminLCX)第12页/共16页Finalresult第13页/共16页PCWPimmediatelyafterPCIwas20mmHg,andCIwas2.1L/min/m2.2dayslater,melenaoccurred.Hemoglobindecreased(from125g/lto68g/l),andPCWPwas5mmHg.800mlRBCwastransfused.Thrombin,aluminiumphosphateandicesalinewasinjectedthroughgastric-tube,andomeprazolewasinjectedintravenously.Aspirin,clopidogrelandLMWHwerecontinuedtoavoidSATinstent.第14页/共16页3dayslater,uppergastrointestinalhemorrhagestopped.Dopamine,IABPandgastric-tubewereremovedgradually.Thepatientwasdischarged16