急性冠脉综合征IVUS能为我们做些什么？.ppt

Cutting balloon + Promus E stent 4.0*12MM to LM 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 FL at 1 year Case 1 IVUS-LSG 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 1、1、0分叉病变 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 twice Angiogram (D4 after admission) patient was asymptomatic and haemodynamically stable. Angiogram CORDIS 6F JL3.5 ，RUNTHROUGH wire， RYUJIN PLUS 2.5*15 Angiogram Angiogram (2013.3.28) Thrombus aspiration at LAD (ThrombusterⅡ Catheter) followed by tirofiban intra-coronary injection. Angiogram (2013.3.28) After Thrombus aspiration + tirofiban administration, vessel opened but sudden cardiopulmonary arrest occurred! After CPR within 20min, the patient’s spontaneous circulation ?breath returned.  Be Careful of Suddenly MI/R Injury after Opening Vessel in High Risk ACS Patient Even without Initial Shock IVUS examination IVUS examination: No plaque at all, only Separation of the layers of the arterial wall was shown Angiogram (2013.3.28) Stent 3.5*32mm to LM/LAD Angiogram (2013.3.28) IVUS examination Followed-up: Angiogram (2013.10.10) Followed-up : Angiogram (2013.10.10) Followed-up: Angiogram (2013.10.10) Followed-up: IVUS examination  (2013.10.10)