1. One case of huge intracoronary thrombus in a patient of AMI Department of Cardiology,Shanghai Tenth People’s Hospital of Tongji University Li Weiming 李伟明 Xu Yawei 徐亚伟 April 1,2010,Beijing CIT2010

2. Case History Present History ： The male patient,40yr, unmarried,was admitted to CCU because of a sudden attack of chest pain for 2hrs, accompanying of nausea,vomit,and profuse sweet Present History ： The male patient,40yr, unmarried,was admitted to CCU because of a sudden attack of chest pain for 2hrs, accompanying of nausea,vomit,and profuse sweet Risk Factors ： Smoking for 20 + yr, a packet of cigarette everyday; Hyperlipidemia,DM Risk Factors ： Smoking for 20 + yr, a packet of cigarette everyday; Hyperlipidemia,DM PE ： P76bpm,BP136/88mmHg;Heart/Lung negative PE ： P76bpm,BP136/88mmHg;Heart/Lung negative Blood biochemistry and main Associated Examinations Blood biochemistry and main Associated Examinations

3. Blood Biochemistry  Blood Routine ： WBC15.5×10 9 /L ， N84% ， RBC 5.12×10 12 /L ， Hb161g/L  Blood biochemistry 1. GPT59 ， GOT638U/L 2. BUN 5.1mmol/L ， Cr 74umol/L ， Uric acid 281umol/L ； FPG 8.9 ， 2hPG 17.7mmo/L ， HbA1c 8.1% ； TC4.01 ， TG1.89 ， HDL-C1.5 ， LDL-C1.65 mmol/L ， LP(a) 85mg/L 3. Trop-T 4.29,Myosin 3000,CK-MB 160ng/ml ； hsCRP5.37 ， BNP 73.1pg/ml

4. ECG 20090927

5. 1. CHD,Acute extensive anterior myocardial Infarction （ AMI ） 2. Hypertension,Grade1,Very High Risk 3. DM,Type 2 Preliminary Diagnosis

6. CAG 2009.09.26 RCA dominant,huge vessel,no severe AS

7. CAG 2009.09.26 Proximal LAD severe stenosis, accompanying a huge thrombus. Distal blood flow is TIMI 2

8. CAG 2009.09.26 Proximal LAD severe stenosis, accompanying a huge thrombus. Distal blood flow is TIMI 2

9. CAG 2009.09.26 Proximal LAD severe stenosis, accompanying a huge thrombus.

10. What’s the Strategies…… 1. Intracoronary thrombolysis? 冠脉内溶栓? 2. Take out the thrombus through the Suction Catheter? 抽吸导管取栓? 3. Direct Stenting? 直接支架术? 4. Predilatation+ Stenting? 预扩＋支架术? 5. Active antithrombotic therapy? 积极抗栓 治疗?

11. Our strategies…… Active antithrombotic therapy 1. Aspirin ＋ Plavix ＋ LMWH 2. Ⅱ b/ Ⅲ a Receptor Antagonist ： Tirofiban （ XinWeining 欣维宁 ） 8ml/h ivgtt, for 36hr （ Note: 15ml iv 3min st ； 0.15ug/kg.min ： 12ml/h ivgtt 36hr ）

12. Three days later…… After 3 days active antithrombotic therapy, the thrombus burden in pLAD decrease clearly 2009.9.262009.9.29

13. Three days later…… 2009.9.262009.9.29

14. 2009.9.262009.9.29

15. 2009.9.262009.9.29

16. What’s our next strategies? 1. …… 2. Direct stenting

17. PCI 2009.09.29 GC:6FXB3.0GW:0.014”BMW Stent (4.0*24mm Endeavor) dilation ， 14atm

18. PCI 2009.09.29 The result is satisfy after direct stenting

19. PCI 2009.09.29 The result is satisfy after direct stenting

20. PCI 2009.09.29 The result is satisfy after direct stenting

21. Take Home Messages…… For the young AMI patient with a huge thrombus, and TIMI 2 blood flow For the young AMI patient with a huge thrombus, and TIMI 2 blood flow 1. The static against the dynamit sometimes is a wise/sagacious choice! 以静制动有时不失是明智之举 2. Enough antithrombotic therapy in the early stage is the most important choice! 早期足量抗栓至关重要 3. Either intravenous infusion or intracoronay injection of Ⅱ b/ Ⅲ a receptor antagonist Tirofeban (XinWeining, 欣维宁 ), is effective and safe!