急診PCI的特殊問(wèn)題罪犯血管的罪犯病變和非罪犯病變(課堂PPT)

1、1,急診PCI的特殊問(wèn)題罪犯血管的罪犯病變和非罪犯病變,信栓力 博士 主任醫(yī)師http:/ ,2,Case baseline data,MV-PCI:罪犯血管和非罪犯血管因支施救：除非有血流動(dòng)力學(xué)紊亂并且非罪犯病變狹窄大于90%時(shí)，一般只處理罪犯病變。 韓雅玲教授的觀點(diǎn)：在有缺血證據(jù)的前提下，在同次住院期內(nèi)處理非罪犯血管。,3,關(guān)注支中重點(diǎn)：罪犯血管的罪犯病變和非罪犯病變：tandem病變、多處病變 急性心肌梗塞時(shí)血管容易痙攣、機(jī)體處于高凝狀態(tài) Tandem病變或彌漫性長(zhǎng)病變一個(gè)支架不能完全覆蓋時(shí)，怎么辦？一個(gè)和多個(gè)支架植入對(duì)預(yù)后的影響是什么？瑞金醫(yī)院張奇做了初步研究

2、。,4,當(dāng)罪犯血管存在tandem病變或彌漫性長(zhǎng)病變時(shí)，如果一個(gè)支架不能完全覆蓋，建議只處理罪犯病變。 且看我院的三個(gè)病例,5,Our hospital case01,Overall views of this puzzle patient,6,image01,Emergency PCI Indicates a ostial total occlusion of LAD-2012.3.26,7,The patients RCA,8,Initial dilation of the culprit lesion,9,Shows the result post initial dilation,10

3、,Cranial projection of LAD,Findings: The right proximal lesion is 85% stenosis There is “normal segment” of 5mm in length but may be not a tandem lesion on this view TIMI flow o grade distal to Diago1,11,After dilation we can see a second lesion-who is the culprit?,12,Someone suspected thrombus in t

4、he distal lesion and think the culprit is right here,What about your opinion ?,13,For the proximal lesion, why it is not the culprit lesion ?,Initial cine shows total occlusion Seriously stenosis after dilation,14,Two culprit lesion? Why the proximal lesion is total occluded? Thrombosis ? Spasm? Bot

5、h? Why the distal lesion also total occluded? A real CTO or sub-acute total occlusion? Total occluded by thrombus from the upstream lesion on base of stenosis?,15,Which is the primary? which is the secondary? Why?,How to cope with them? What should we do for next step?,16,Merely Implanted partner st

6、ent in the distal lesion! Right?,17,2012.4.8 selective pci .,18,Final results after stent implantation on 8 April 2012,19,case02罪犯血管的長(zhǎng)病變的處理,20,21,Post Dilatation ,22,Avoiding long stent implantation,23,Final result,24,case03,25,26,27,Investigation after dilation,28,More carefully investigation,29,1、Predilate 2、stent position 3、implantation,30,Cope with proximal segment,31,Implantation and postdilation,32,Final cine,33,But symptom developed,34,35,Dissection?,36,Finished,37,