急性冠脉综合征IVUS能为我们做些什么？课件.ppt

急性冠脉综合征——IVUS能为我们做些什么？ 血栓: Why ? Case 2 ECG : aVR  CCU检查 UCG 梅毒性冠脉病变特点： 树胶样肿 仅累及开口，“鸟嘴样”改变 慢性侧枝循环开放 合并主动脉瓣病变 Case 1 IVUS-LSG Thrombosis in native vessel vs. SVG STENT 3.0*28, 3.5*15 殊路异归 Attenuated Plaque Attenuated 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 NIRS/IVUS 男，55岁 发作性胸闷2月，加重1周 高血压病史7年 EKG广泛胸前导联ST压低 心肌酶（+） 冠状动脉造影 冠状动脉造影 LAD 病变 ？ 血管内超声 1mm A B C D A B C D IVUS: AP (deep) IVUS: AP (superficial) IVUS: AP (superficial) IVUS: AP (deep) 1mm 1mm 1mm 1mm LP Early NC Late NC Late NC －How iMAP Looks like? ACS Patient without No-refolw Patient Information Baseline 58 year-old Male Acute chest pain for 4 hrs TNI CK EKG II III aVF HBP DM Smoke Baseline Symptoms Lab test Risk factors Angiogram (LCA) Angiogram (RCA) NIRS/IVUS FL at 1 year III：桥血管病变 Laboratory tests and examination  心肌酶  Angiogram (9/28/2012) Radial Acess, TIG: pLAD CTO, mLCX 30% lesion mRCA CTO SVG-LAD: patency Totally occluded SVG to RCA JR/ SAL /3DRC AL failed, then MPA GC was chosen THROMBUS II could not get though Tirofiban intracoronary from THROMBUS II THROMBUS II *4 Distal Prox MLA IV：AT病变 Mt. St. Helens, WA, USA 不稳定斑块 急性心肌梗死 Baseline 男性，71岁 Symptoms 间断性胸痛3月，加重1w Risk factors DM病史 HBP病史 Diagnostic examination ECG：胸前导联V1-5ST段压低 心肌酶: （－） II：左主干病变 Patient Information 基线特征 58 岁女性 症状 急性胸痛 2 天 实验室检查 TNI 15.35 ng/ml CK 1407 IU/L BNP 234.00 pg/ml 危险因素 无 ECG at Admission Transferred to CCU: haemodynamically stable. Medical Therapy Antiplatelet DAPT loading dose Aspirin 100mg Clopidogrel 75mg daily Anticoagulation Enoxaparin iH Bid Statin Atrovastatin 40mg qN ACEI β-Blocker Lotensin 5mg daily and Metoprolol 12.5mg twic