右冠脉分叉演示文稿.pptVIP

RCA Bifurcation Jin Zening Beijing Anzhen Hospital Beijing, CHINA History Male, 54 Years 3 years history of increasing exertional chest pain despite of use Aspirin，Felodipine， Losartan， Metoprolol，Atorvastatin and Isosorbide Mononitrate 11 years history of hypertension 31 years history of ongoing tobacco use No diabetes mellitus Laboratory CK: 148U/L，CKMB: 7U/L Troponin：negative TG：3.07mmol/L；TCHO：5.41mmol/L；HDL：0.9mmol/L；LDL-C：3.55mmol/L BUN：98mmol/L；Serum Creatinine：87umol/L ECG：Non specific ST-T change UCG：EF 53%; LV 35/49 mm Coronary Angiography Coronary Angiography Coronary Angiography Coronary Angiography TCT 2005, Morice MC 1,1,1 1,1,0 1,0,1 0,1,1 1,0,0 0,1,0 0,0,1 Medina type TECHNIQUES Femoral Approach 7F Femoral Sheath Plan 7F AL 0.75 or XBRCA，but… So 7F JR 3.5 Guide Wire：Cronus Moderate Support 0.014”*210cm Magnetic Navigating System 2 DES The Cronus Guide Wire can’t advance into PDA Put ASAHI Rinato GW into PLA, Use Voyager 2.5×15 dilate （6atm×10”） Put ATW Marker Wire into PDA, then use Ryujin 1.5×15 and Sprinter 2.5×15 dilate the ostium of PDA But… The Guide catheter’s backup is not strong enough, we can’t advance a Cypher select 2.75×33 stent to the PLA. Deep seating, Buddy wire, Using a balloon as a slide track…Doesn’t work!! At last, we can’t even advance a balloon into distal of RCA! Finally Change the guide catheter: 6F AL1 But the waveform damping on hemodynamic monitor, and the QRS wave of ECG becoming wide. Made a side hole on the AL1 catheter Re-cross both guide wire Crush 1.Cypher 2.75×33 (16atm) 2.Cypher 2.5×13 (14atm) 3.Voyager 2.5×15 4.Cypher 3.0×28 (20atm) Dissection of RCA by AL1 Cypher 3.0×28 (20atm) Final Result Final Result About 3 hours Contrast Agents: Iohexol 425ml One day after PCI: BUN:4.98mmol/L Creatinine:87umol/L ADP: 27% AA:11% * 放弃磁导航，因为判断不可能通过 * 反复尝试失败 * 没有Kissing, 因为6F