A AMI PATIENT WITH VERY VERY LATE THROMBOSIS IN THE STENT 极极晚期支架内血栓致急性心肌梗死 1 例 DEPARTMENT OF CARDIOLOGY OF GENERAL HOSPITAL OF CHINESE PEOPLE’S ARMED POLICE.

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Presentation transcript:

A AMI PATIENT WITH VERY VERY LATE THROMBOSIS IN THE STENT 极极晚期支架内血栓致急性心肌梗死 1 例 DEPARTMENT OF CARDIOLOGY OF GENERAL HOSPITAL OF CHINESE PEOPLE’S ARMED POLICE FORCES YANG SHENGLI 武警总医院心内科杨胜利

Clinical manifestation Patient CHEN YANGBAO, male, 82 years old 。 “There are sevent years after AMI with PCI, Chest pain for 3 hours” admitted to WJ GENERAL HOSPITAL at 10:30AM 30/04/2012 History/Risk factors: Hypertension ， Smoking for 30 years. NO history of Diabetes mellitus PCI ： LADd,m,p implanted stents with Firebird2.5*23mm 、 3.0*33mm 、 3.0*29mm, LCXp implanted stent with Firebird 3.0*23mm. Regular oral Aspirin 100mg Qd 、 Plavix 75mg Qd for one year. CREATININE ： 92umol/L; eGFR: 73ml/min/1.73m2

复查

： 30 BP ： 130/70mmHg

： 00

Emergency PCI ： :10PM

左冠状动脉造影

右冠状动脉造影

6F XBLAD GC PT2 LS GW into LADd

DIVER CE to LADp ， failed pass stent in LADp

After thrombus aspiration

Runthrough GW to LCXd DIVER CE failed to LCX stent

After thrombus aspiration

Voyager 2.5 *15mm-----LCX

Voyager 3.0*15mm----LCX

LCX-PTCA

Voyager 2.0*12mm----LAD

： 10 术后

： 10

： 55

Biomarker change CKMB Normal range 0-4.3ng/ml MYO Normal range 0-107ng/m TNI Normal range 0-0.4ng/m >80488>

Drug treatment: Aspirin 100mg qd Plavix 75mg qd Tirofiban 10ug/kg （ 10ml ） iv ， 0.15ug/kg/min （ 6ml/h ） 3 days. LWFH 40mg Q12h Atovastatin 20mg qd

CAG+PCI ：

6F XBLAD3.5; BMW

VOYAGER NC2.5*15mm------LAD

VOYAGER NC2.75*15mm----LAD

VOYAGER NC3.0*20mm

VOYAGER NC3.0*20mm--LADp

XIENCEV3.5*18mm-----LADp

VOYAGER NC3.5*15mm

Runthrough

VOYAGER NC2.0*15mm

Discussion Is this is a very very late stent thrombosis? If yes, Cause of stent thrombosis? Stent Underexpansion? How to treat this patient with PCI? Is the Strategy right? First PCI and second PCI? How long to use ADP recepter blocker? IABP ? IVUS ? Is the stent implanted right? Is the Ostial of LCX POBA right?

THANKS ！