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Left Main Severe Dissection and Occlusion during PCI PCI 并发左主干严重撕裂闭塞

Left Main Severe Dissection and Occlusion during PCI PCI 并发左主干严重撕裂闭塞. ZHANG Bin MD. PhD Guangdong General Hospital Guangdong Provincial Cardiovascular Institute 张 斌 广东省人民医院 广东省心血管病研究所 心内科. Clinical presentation.

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Left Main Severe Dissection and Occlusion during PCI PCI 并发左主干严重撕裂闭塞

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  1. Left Main Severe Dissection and Occlusion during PCI PCI并发左主干严重撕裂闭塞 ZHANG Bin MD. PhD Guangdong General Hospital Guangdong Provincial Cardiovascular Institute 张 斌 广东省人民医院 广东省心血管病研究所 心内科

  2. Clinical presentation • Mr. G.J.S. 71-yr-old，a former National canoeing team player in 1950’s, had a history of exertional chest pain for 2 months. He had 2-3 episodes every week. Each lasted from half to 2 hours. • CADRF: Hypertension • PE: Bp: 164/88mmHg. HR: 63 bpm, S1,S2, regular rhythm, no murmur

  3. Lab：CHOL: 4.37mmol/L；LDL 3mmol/L；HDL: 0.84mmol/L, Cr: 125umol/L • ECG: T waves reversed • UCG：LVDd：54mm，LVDs：41mm。LVEF 47%。Mild mitral regurgitation (Area: 2.2cm2)

  4. CAG 2009,6,30 Transradial approach, 5 F Tig catheter

  5. Try to persuade the patient to accept CABG therapy because all evidences indicated CABG • However, the patient and family refused CABG

  6. PCI on 2009,7,2 Transfemoral, Heparin 10000u 7F XB 3.5 Guiding Catheter Runthrough wire

  7. 2.0×15 mm Balloon 2.5×18 mm Firebird stent was difficult to reach the middle lesion

  8. 2.75×23 mm stent was implanted at Pro LAD quickly Prox LAD almost occluded Pt still felt well

  9. 3.0×28 mm stent was implanted at Pro LAD

  10. 2.0×15mm Balloon 2.5×18mm stent

  11. 3.5×18mm Stent

  12. Fix it or not? It’s a problem.

  13. 3.0×13mm Stent 5F Heartrail Guiding Catheter in 7F XB 3.5

  14. Should I stop here?

  15. 3.0×18mm Stent

  16. Pt complaint chest pain

  17. Pt lost consciousness Angiography showed no flow in LCA Quickly dilated LM with 3.5 ×15 mm Balloon

  18. Blood flow restored, but looked ugly. There was big dissection in LM

  19. Eventually, recovered very well without symptoms • Pt was transfered into CCU • Transfer into normal ward after 1-day-CCU • 3-day-uneventful stays after procedure

  20. I still don’t know how to manage it when dissection combines with thrombus

  21. Tolerance of ischemia had improved in follow-up • Pt asked for further PCI to RCA • Coronary CT done 3 months after PCI

  22. Take home messages • Do not rob the surgeon’s job • “Perfect” is the enemy of “good”

  23. Thank you for your attention!

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