急性心梗患者急诊经桡动脉行PCI—策略和技巧(英文版）PPT.pptVIP

Emergent PCI in AMI Patientswith transradial approach—Strategy and Skills;Introduction; According to the most recent guidelines, patients with TFA undergo aggressive anticoagulation, which leads eventually to an increased incidence of bleeding(up to 7%). However, the combination of GP IIb/IIIa inhibitors and catheterisation withTRA is virtually avoid from serious bleeding.; Louvard et al. in the first 50 cases, demonstrated that any operator will have a failure of about 10%, which will drop to 3-4% after other 500 cases, however procedural failure will stabilise after 1000 procedures at less than 1%. A operator who performed 500 cases may be regarded as the experienced operator for emergent TRA PCI. Indeed,TRA may find its most suitable application in patients with ACS/ STEMI. ;A 47-year-old male Severe chest pain for 3 hours A history of hypertension, hyperlipidemia ECG: precordial leads showing up to 3 mm ST elevation in leads V1–V4 ;Case 1;Case 1;Case 1;DIVER CE;Case 1;Case 1;Case 1;Case 1;Case 1;If aspirate the thrombus first, the result maybe better. ;A 72-year-old male Severe chest pain for 3 hours Tri-chamber pacemaker implantation two years ago ECG: ST-segment elevation in leads II, III, aVF ;Case 2;Case 2;Case 2;Case 2;TAPAS In the thrombus-aspiration group, direct stent implantation were performed in 55.1% cases. In the conventional- PCI group, 98.8% cases need balloon predilation.;It has been reported that more than half of the culprit lesions(66%) in AMI patients with stenosis 50% and in majority patients(97%) the stenosis were less than 70%.;Diver CE aspiration catheter ;;Case 3;Case 3;Case 3;Case 3;Case 3;Case 3;Case 3;Case 3;Case 3;Case 3;A: The stent is advanced to the ostial branch lesion and a second balloon is placed in the main branch;C: The stent is deployment at high pressures; When needed, and in selected patients,such as males with good pulsation,