急诊PCI治疗STEMI是否同时行吸栓术 David.ppt

Should Thrombectomy be Used in Primary PCI for STEMI (TAPAS) David X. Zhao, MD., FACC, FSCAI Harry and Shelley Page Professor of Medicine in Interventional Cardiology Director, Cardiac Catheterization Laboratory Interventional Cardiology Vanderbilt University Medical Center Nashville, TN USA Thrombus in ACS PCIThrombus = MACE Thrombus Burden Manual Aspiration AngioJet: Mechanisms AngioJet versus Aspiration MACE in STEMI: The Importance of Thrombus Burden and Thrombectomy Thrombectomy in STEMI Pooled Analysis of 11 Trials Thrombectomy in STEMI Pooled Analysis of 11 Trials Thrombus Aspiration during Primary PCI in Acute STEMI (TAPAS) Thrombus Aspiration during Primary PCI in Acute STEMI (TAPAS) Conclusion Selective use of thrombectomy in patients with large thrombus during PCI for ACS is associated with better procedural outcomes, in-hospital and mid term MACE-free survival. Meta-analysis demonstrates that AngioJet is safe and effective in a high risk AMI cohort. Thrombectomy is advised in patients with AMI and large thrombus burden before stenting. Manual aspiration: Small thrombus AngioJet: Large thrombus or failed manual aspiration Choosing the Right Tools Thrombus Aspiration during Primary PCI in Acute STEMI (TAPAS) NEJM 2008;358:557 Small thrombus Large thrombus Extensive Thrombus * TIMI study group defined thrombus grade first … Circulation 2001;103;2550-2554 * * * * TIMI study group defined thrombus grade first … Circulation 2001;103;2550-2554 * * * 急诊PCI治疗STEMI是否同时行吸栓术 (TAPAS) David X. Zhao, MD., FACC, FSCAI Harry and Shelley Page Professor of Medicine in Interventional Cardiology Director, Cardiac Catheterization Laboratory Interventional Cardiology Vanderbilt University Medical Center Nashville, TN USA ACS PCI时的血栓血栓 = 主要心脏不良事件 血栓 TIMI分级 吸栓术 血栓负荷 血栓抽吸术的设备 13 血栓去除自动装置 人工抽吸 真空负压 –600 mmHg 真空负压 – 10 mmHg 人工抽吸 血栓抽吸自动装置原理 自动装置与人工抽吸比较 自动装置与人工抽吸有效区域对比 STEMI时的主要心脏不良事件：血栓负荷和吸栓术的重要性 JACC 2007:50:572 STEMI时支架内血栓: 血栓负荷和吸栓术的重要性 JACC 2007:50:572 Burzotta, F.