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1、EmergentPCIinAMIPatientswithtransradialapproach—StrategyandSkillsWeiminLi,MDTheFirstAffiliatedHospitalHarbinMedicalUniversity,Harbin,ChinaIntroductionAtthebeginning,TRAtendedtobeavoidedinAMIpatients.Majorconcernwasanexpectedlongertimeforarterialcannulation.Manyst
2、udieshavenowdemonstratedthesafety,feasibilityandgoodoutcomesofprimaryPCIperformedwithTRA,andwithadrasticreductioninvascularcomplicationsandlengthofin-hospitalstays.Accordingtothemostrecentguidelines,patientswithTFAundergoaggressiveanticoagulation,whichleadseventual
3、lytoanincreasedincidenceofbleeding(upto7%).However,thecombinationofGPIIb/IIIainhibitorsandcatheterisationwithTRAisvirtuallyavoidfromseriousbleeding.IntroductionLouvardetal.inthefirst50cases,demonstratedthatanyoperatorwillhaveafailureofabout10%,whichwilldropto3-4%af
4、terother500cases,howeverproceduralfailurewillstabiliseafter1000proceduresatlessthan1%.Aoperatorwhoperformed500casesmayberegardedastheexperiencedoperatorforemergentTRAPCI.Indeed,TRAmayfinditsmostsuitableapplicationinpatientswithACS/STEMI.IntroductionA47-year-oldmale
5、Severechestpainfor3hoursAhistoryofhypertension,hyperlipidemiaECG:precordialleadsshowingupto3mmSTelevationinleadsV1–V4Case1Theincidenceofslowflowandno-reflowafterPrimaryPCIisupto10%-20%,especiallyhighinlesionswithlargethrombusburdenCase1Case1Ryujin2.5x20Case1Case1Ca
6、se1DIVERCECase1Case1Case1Case1Case1OMthrombusaspirationCase1Ifaspiratethethrombusfirst,theresultmaybebetter.A72-year-oldmaleSeverechestpainfor3hoursTri-chamberpacemakerimplantationtwoyearsagoECG:ST-segmentelevationinleadsII,III,aVFDirectstentingstrategyisfeasiblein
7、mostofemergentPCIcasesafterthrombusaspiration.Case2Case2Case2DIVERCECase2Nitroglycerin200μgCase2DirectstentingTAPASInthethrombus-aspirationgroup,directstentimplantationwereperformedin55.1%cases.Intheconventional-PCIgroup,98.8%casesneedballoonpredilation.PCR2008Itha
8、sbeenreportedthatmorethanhalfoftheculpritlesions(66%)inAMIpatientswithstenosis<50%andinmajoritypatients(97%)thestenosiswerelessthan70%.WCLittle,e