one patient, two years, three choices, four pci zhao peng cardiology , the affiliated hospital of...
TRANSCRIPT
![Page 1: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/1.jpg)
One patient, two years, One patient, two years, three choices , four PCIthree choices , four PCI
ZHAO Peng
Cardiology, the Affiliated Hospital of Medical College of CPAPF, Tianjin, China
![Page 2: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/2.jpg)
Case presentation
• Male , 61 years old• Chest pain for 4 hours• ECG : ST segment elevation on V1-V5 lea
d• Smoking 、 hypertension 、 hyperlipidem
ia• No diabetes mellitus• Diagnosis: Acute myocardial infarction
![Page 3: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/3.jpg)
Coronary angiography
![Page 4: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/4.jpg)
![Page 5: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/5.jpg)
![Page 6: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/6.jpg)
![Page 7: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/7.jpg)
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 suppl
y
![Page 8: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/8.jpg)
Balloon : 2.5*14mm
Pressure : 8atm
After nitro. bolus , TIMI-3 flow
![Page 9: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/9.jpg)
Stent 1: Cypher 3.0*18mmPressure:12atm
![Page 10: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/10.jpg)
Stent 2: Cypher 3.0*23mmPressure:16atm
![Page 11: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/11.jpg)
The final film
![Page 12: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/12.jpg)
Patient condition
• The symptom of angina disappeared• Vital sign were stable• Echocardiograph showed LVEF 42%
![Page 13: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/13.jpg)
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 wer
e satisfactory• So, WHY?
![Page 14: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/14.jpg)
Recheck Coronary Angiography
![Page 15: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/15.jpg)
LM ostial-proximal lesion
![Page 16: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/16.jpg)
![Page 17: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/17.jpg)
LCX ostial lesion
![Page 18: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/18.jpg)
No lesion in RCA
![Page 19: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/19.jpg)
Unstable plaque in LM and LCX
IVUS check
![Page 20: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/20.jpg)
What’s the next?
• CABG? PCI?• Our determination : PCI No calcification lesion, easily transport devices DES , seldom restenosis Checked by IVUS , perfect stent- adherent
![Page 21: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/21.jpg)
LCX, Balloon dilation, 3.0*15mm , 12atm
![Page 22: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/22.jpg)
Stent location
![Page 23: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/23.jpg)
Stent : Endeavor 4.0*24mmPressure:16atm
![Page 24: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/24.jpg)
Kissing balloon
LM 4.0*24mm 16atm
LAD 3.0*13mm 16atm
![Page 25: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/25.jpg)
Stent implanted, checked by IVUS, perfect stent-adherent
![Page 26: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/26.jpg)
Patient condition• The symptom of angina disappeared again
after PCI• UCG: LVEF45%• Take more drug , adding cilostazol • No symptom for 1 year, recheck coronary a
ngiography
![Page 27: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/27.jpg)
Coronary angiography
![Page 28: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/28.jpg)
What we can do?
• Clinical observation ?• CABG ?• PCI ?• After the communication with the patien
t’s kin, the final choice was PCI
![Page 29: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/29.jpg)
LAD ostial lesion
Cutting Balloon 3.5*6mm
8atm
![Page 30: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/30.jpg)
LAD ostial lesion
LCX ostial lesion
![Page 31: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/31.jpg)
LCX ostial lesion
Cutting balloon 3.5*6mm
8atm
![Page 32: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/32.jpg)
Cypher 3.5*23mm
Located to LM ostium
18atm
![Page 33: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/33.jpg)
Kissing balloon
LAD 3.5*15mm 12atm
LCX 3.5*15mm 12atm
![Page 34: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/34.jpg)
LM, the stent’s corollas overlapped
![Page 35: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/35.jpg)
The final film
![Page 36: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/36.jpg)
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
![Page 37: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/37.jpg)
The bulk of thrombus filled LM, proximal LAD and LCX, the blood of LAD was TIMI-2 grade
![Page 38: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/38.jpg)
What we can do?
• We had no choice besides PCI• IABP• Thrombus suction • anticoagulants• Vasoactive agent
![Page 39: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/39.jpg)
Sucking thrombus
TIMI-3 flow
![Page 40: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/40.jpg)
The final film
![Page 41: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/41.jpg)
Present condition
• Persistent IABP for 4 days• Twice acute heart failure • 7 days in CCU• UCG: LVEF 25%• Underwent CABG after 4 weeks
![Page 42: One patient, two years, three choices, four PCI ZHAO Peng Cardiology , the Affiliated Hospital of Medical College of CPAPF, Tianjin, China](https://reader036.vdocuments.net/reader036/viewer/2022062408/56649f155503460f94c2b628/html5/thumbnails/42.jpg)
Thanks !