急性心梗患者急诊经桡动脉行PCI—策略和技巧(英文版).ppt
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1、Emergent PCI in AMI Patients with transradial approach Strategy and Skills,Weimin Li, MD,The First Affiliated Hospital Harbin Medical University, Harbin, China,Introduction,At the beginning,TRA tended to be avoided in AMI patients. Major concern was anexpected longer time for arterial cannulation .
2、Many studies have now demonstrated the safety, feasibility and good outcomes of primary PCI performed with TRA,and with a drastic reduction in vascular complications and length of in-hospital stays.,According to the most recent guidelines, patients with TFA undergo aggressive anticoagulation, which
3、leads eventually to an increased incidence of bleeding(up to 7%). However, the combination of GP IIb/IIIa inhibitors and catheterisation withTRA is virtually avoid from serious bleeding.,Introduction,Louvard et al. in the first 50 cases, demonstrated that any operator will have a failure of about 10
4、%, which will drop to 3-4% after other 500 cases, however procedural failure will stabilise after 1000 procedures at less than 1%. A operator who performed 500 cases may be regarded as the experienced operator for emergent TRA PCI. Indeed,TRA may find its most suitable application in patients with A
5、CS/ STEMI.,Introduction,A 47-year-old male Severe chest pain for 3 hours A history of hypertension, hyperlipidemia ECG: precordial leads showing up to 3 mm ST elevation in leads V1V4,Case 1,The incidence of slow flow and no-reflow after Primary PCI is up to 10%-20%, especially high in lesions with l
6、arge thrombus burden,Case 1,Case 1,Ryujin 2.5 x 20,Case 1,Case 1,Case 1,DIVER CE,Case 1,Case 1,Case 1,Case 1,Case 1,OM thrombus aspiration,Case 1,If aspirate the thrombus first, the result maybe better.,A 72-year-old male Severe chest pain for 3 hours Tri-chamber pacemaker implantation two years ago
7、 ECG: ST-segment elevation in leads II, III, aVF,Direct stenting strategy is feasible in most of emergent PCI cases after thrombus aspiration.,Case 2,Case 2,Case 2,DIVER CE,Case 2,Nitroglycerin 200g,Case 2,Direct stenting,TAPAS In the thrombus-aspiration group, direct stent implantation were perform
8、ed in 55.1% cases. In the conventional- PCI group, 98.8% cases need balloon predilation.,PCR 2008,It has been reported that more than half of the culprit lesions(66%) in AMI patients with stenosis 50% and in majority patients(97%) the stenosis were less than 70%.,WC Little,et al. Circulation 1988;78
9、;1157-1166,Diver CE aspiration catheter,Distal radiopaque marker band:1 mm proximal to the tip,Oblique aspiration tip: lumen ID=0.9mm,Side hole diameter: 1.5mm,The proximal segment(20cm) has a hydrophilia coating .,Prevention is better than cure. Risk features. (clinical and angiographic features),L
10、arge IRA (3.5mm) Cut-off pattern Accumulated thrombus 5mm Non-occluded thrombus with linear dimension 3 RVD Floating thrombus (proximal to the occlusion); Persistent dye stasis (distal to the obstruction).,Wall motion integration TIMI grade of IRA Lack angina before AMI Number of leads with patholog
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