One patient, two years, three choices, four PCI ZHAO Peng Cardiology ， the Affiliated Hospital of Medical College of CPAPF, Tianjin, China.

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Presentation transcript:

One patient, two years, three choices, four PCI ZHAO Peng Cardiology ， the Affiliated Hospital of Medical College of CPAPF, Tianjin, China

Case presentation Male ， 61 years old Chest pain for 4 hours ECG ： ST segment elevation on V1-V5 lead Smoking 、 hypertension 、 hyperlipidemia No diabetes mellitus Diagnosis: Acute myocardial infarction

Coronary angiography

Treatment strategy Open the culprit vessel as early as possible Use coil wire to avoid into the false lumen Crush the thrombus by balloon dilation Implant stent to restore the blood supply

Balloon : 2.5*14mm Pressure ： 8atm After nitro. bolus ， TIMI-3 flow

Stent 1: Cypher 3.0*18mm Pressure:12atm

Stent 2: Cypher 3.0*23mm Pressure:16atm

The final film

Patient condition The symptom of angina disappeared Vital sign were stable Echocardiograph showed LVEF 42%

11 months later Intermittent chest pain for 5 days ECG on symptom: ST segment elevation on avR lead No drug terminate Stop smoking Blood pressure, glucose and lipoids were satisfactory So, WHY?

Recheck Coronary Angiography

LM ostial-proximal lesion

LCX ostial lesion

No lesion in RCA

Unstable plaque in LM and LCX IVUS check

What’s the next? CABG? PCI? Our determination ： PCI No calcification lesion, easily transport devices DES ， seldom restenosis Checked by IVUS ， perfect stent- adherent

LCX, Balloon dilation, 3.0*15mm ， 12atm

Stent location

Stent : Endeavor 4.0*24mm Pressure:16atm

Kissing balloon LM 4.0*24mm 16atm LAD 3.0*13mm 16atm

Stent implanted, checked by IVUS, perfect stent-adherent

Patient condition The symptom of angina disappeared again after PCI UCG: LVEF45% Take more drug, adding cilostazol No symptom for 1 year, recheck coronary angiography

Coronary angiography

What we can do? Clinical observation ？ CABG ？ PCI ？ After the communication with the patient’s kin, the final choice was PCI

LAD ostial lesion Cutting Balloon 3.5*6mm 8atm

LAD ostial lesion LCX ostial lesion

Cutting balloon 3.5*6mm 8atm

Cypher 3.5*23mm Located to LM ostium 18atm

Kissing balloon LAD 3.5*15mm 12atm LCX 3.5*15mm 12atm

LM, the stent’s corollas overlapped

The final film

7 days later Chest pain exploded, cold sweat and shock ECG: ST segment elevation on avR lead and depression on V1-V6 lead Troponin T was elevated treatment ： IV tirofiban coronary angiography

The bulk of thrombus filled LM, proximal LAD and LCX, the blood of LAD was TIMI-2 grade

What we can do? We had no choice besides PCI IABP Thrombus suction anticoagulants Vasoactive agent

Sucking thrombus TIMI-3 flow

The final film

Present condition Persistent IABP for 4 days Twice acute heart failure 7 days in CCU UCG: LVEF 25% Underwent CABG after 4 weeks

Thanks !