1. 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

2. 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. 2005 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

3. 2009-11-3 复查

4. 2012-4-30 12 ： 30 BP ： 130/70mmHg

5. 2012-4-30 13 ： 00

6. Emergency PCI ： 2012-4-30 1:10PM

7. 左冠状动脉造影

8. 右冠状动脉造影

9. 6F XBLAD GC PT2 LS GW into LADd

10. DIVER CE to LADp ， failed pass stent in LADp

11. After thrombus aspiration

12. Runthrough GW to LCXd DIVER CE failed to LCX stent

13. After thrombus aspiration

14. Voyager 2.5 *15mm-----LCX

15. Voyager 3.0*15mm----LCX

16. LCX-PTCA

17. Voyager 2.0*12mm----LAD

21. 2012-4-30 16 ： 10 术后

22. 2012-5-2 14 ： 10

23. 2012-5-8 14 ： 55

24. Biomarker change CKMB Normal range 0-4.3ng/ml MYO Normal range 0-107ng/m TNI Normal range 0-0.4ng/m 2012-4-30 >80488>30 2012-5-1 4.910914.2

26. 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

27. CAG+PCI ： 2012-5-10

28. 6F XBLAD3.5; BMW

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

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

32. VOYAGER NC3.0*20mm

35. VOYAGER NC3.0*20mm--LADp

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

39. VOYAGER NC3.5*15mm

43. Runthrough

44. VOYAGER NC2.0*15mm

49. 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?

50. THANKS ！