急性冠脈綜合征IVUS能為我們做些什么？

1、急性冠脈綜合征IVUS能為我們做些什么？Mt. St. Helens, WA, USAPLAQUE RUPTURE 60-80% PLAQUE EROSION 20-40%CALCIFIED NODULE 2-7 %殊路異歸殊路異歸IVUS克服了血管造影的局限克服了血管造影的局限危險(xiǎn)因素危險(xiǎn)因素高血壓高脂血癥Diagnostic examination ECG :STEMI 前壁心肌酶 基線特征基線特征74 歲女性癥狀癥狀急性胸痛 1小時(shí)2 月前月前 : LM: 輕度管壁不規(guī)則輕度管壁不規(guī)則RCA: 輕度管壁不規(guī)則輕度管壁不規(guī)則LCX: LCX 近段彌漫性輕度病變近段彌漫性輕度病變LAD: L

2、AD 近中段近中段20% stenoses ; D1 開口開口70-80% stenosis Xience V DESLVG: 室壁運(yùn)動(dòng)正常室壁運(yùn)動(dòng)正常; EF=60%. Case 2 斑塊分布在邊支對(duì)面 邊支閉塞可能較小基線特征基線特征 58 歲女性歲女性癥狀癥狀 急性胸痛急性胸痛 2 天天實(shí)驗(yàn)室檢查實(shí)驗(yàn)室檢查 TNI 15.35 ng/ml CK 1407 IU/L BNP 234.00 pg/ml 危險(xiǎn)因素危險(xiǎn)因素 無(wú)無(wú)ECG at Admission patient was asymptomatic and haemodynamically stable.CORDIS 6F JL3.5

3、 ，RUNTHROUGH wire， RYUJIN PLUS 2.5*15Angiogram (2013.3.28)Thrombus aspiration at LAD (Thrombuster Catheter) followed by tirofiban intra-coronary injection.Angiogram (2013.3.28)After Thrombus aspiration + tirofiban administration, vessel opened but sudden cardiopulmonary arrest occurred!After CPR wit

4、hin 20min, the patients spontaneous circulation & breath returned.IVUS examinationIVUS examination: No plaque at all, only Separation of the layers of the arterial wall was shown Angiogram (2013.3.28)Stent 3.5*32mm to LM/LADAngiogram (2013.3.28)Followed-up: Angiogram (2013.10.10)Followed-up : An

5、giogram (2013.10.10)Followed-up: Angiogram (2013.10.10)Followed-up: IVUS examination (2013.10.10)Case 1：Patient InformationRisk factors NoDiagnostic examination ECG : aVR Cardiac enzyme levels Baseline28 year-old FemaleSymptomsChest pressure for 3 Days ECG : aVR 壓力壓力Down 當(dāng)導(dǎo)管碰到左主干口！當(dāng)導(dǎo)管碰到左主干口！壓力壓力Down

6、 釣魚技術(shù)釣魚技術(shù)球囊預(yù)擴(kuò)張后彈性回縮！球囊預(yù)擴(kuò)張后彈性回縮！開口部位的冠脈壁組織與其它節(jié)段有所不同開口部位的冠脈壁組織與其它節(jié)段有所不同 -膠原和彈力纖維成分大膠原和彈力纖維成分大 -有血管負(fù)性重構(gòu)的因素有血管負(fù)性重構(gòu)的因素尤其是位于尤其是位于“冠脈樹冠脈樹”根部的根部的LMCutting balloon + Promus E stent 4.0*12MM to LMCCU檢查檢查UCG梅毒性冠脈病變特點(diǎn)：梅毒性冠脈病變特點(diǎn)：樹膠樣腫樹膠樣腫僅累及開口，僅累及開口，“鳥嘴樣鳥嘴樣”改變改變慢性側(cè)枝循環(huán)開放慢性側(cè)枝循環(huán)開放合并主動(dòng)脈瓣病變合并主動(dòng)脈瓣病變FL at 1 yearCase 1 I

7、VUS-LSG Radial Acess, TIG: pLAD CTO, mLCX 30% lesion mRCA CTOSVG-LAD: patencyTotally occluded SVG to RCA JR/ SAL /3DRC & AL failed, then MPA GC was chosen THROMBUS II could not get thoughTirofiban intracoronary from THROMBUS II THROMBUS II *4Thrombosis in native vessel vs. SVGSTENT 3.0*28, 3.5*1

8、5DistalProxMLAMt. St. Helens, WA, USABaseline男性，男性，71歲歲Symptoms間斷性胸痛間斷性胸痛3月，加重月，加重1wRisk factors DM病史病史HBP病史病史Diagnostic examination ECG：胸前導(dǎo)聯(lián)：胸前導(dǎo)聯(lián)V1-5ST段壓低段壓低心肌酶心肌酶: （）（）Attenuated Plaque1mmABCDABCDIVUS: AP (deep)IVUS: AP (superficial) IVUS: AP (superficial) IVUS: AP (deep)1mm1mm1mm1mmLPEarly NCLate

9、 NCLate NCHow iMAP Looks like?ACS Patient without No-refolwAttenuated plaque is an IVUS finding that indicated the presence of large lipid/necrotic core Associated with no-reflow in patients with coronary artery disease undercgoing PCI Patient InformationBaseline 58 year-old Male Acute chest pain for 4 hrs TNI CK EKG II