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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二层,第三层,第四层,第五层,*,*,*,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，100853,11/6/2024,1,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 22,2021 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%,11/6/2024,2,11/6/2024,3,11/6/2024,4,11/6/2024,5,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?,11/6/2024,6,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,11/6/2024,7,11/6/2024,8,11/6/2024,9,A morning,3 days later,11/6/2024,10,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?,11/6/2024,11,谢 谢,11/6/2024,12,
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