Emergent PCI for LM DiseaseEmergent PCI for LM Disease解放军总医院解放军总医院 全军心血管病研究全军心血管病研究 所所心血管病中心心血管病中心 心血管内科心血管内科王王 禹禹 王峙峰王峙峰（北京（北京 复兴路复兴路2828号，号，100853100853）2018/7/141General SituationYuan XX, male 75 yrs; Hypertension for 20 yrs, NIDDM for 10 yrs; 2 yrs ago,had 2 DES in LAD (no detail) Severe chest pain, with heavy sweat on March 22,2008 8:30 am. With V2-V6 ST segment elevation. About 10:20 am, the emergent coronary angiogram was done. HR: 89/min, BP: 110/75mmHg,PO2: 98%Date2Date3Date4Date5Whats the Strategy, next? PCI or emergent CABG ?1 PCI, whats the strategy for this critical lesion?Do CX first, or touch LAD first? 2 Does this situation need IABP support or no? 3 put DES or BMS, as the patient had 2 DES in LAD? T stent, provisional-T crush or be select? 4 We fully dilated all segment of old DES or just make it TIMI-3 flow?Date6What we had done? Emergent PCI with IABP support1 IABP first, even the hemodynamic looks stable; 2 7F EBU 3.5, wire LAD and CX with BMW; 3 Inflate the CX high severe lesion first, with 2.5-15mm world-pass balloon, then extracting the occluded LAD with Diver CE; then inflate the LAD from stent to the ostium with 2.5-15; Put Endeavor 3.5-18 and Firebird 3.0-23 stent from LM to mid-CX with 18atm; Re-cross wire into LAD, inflate stent, then put another EXCEL 3.0-14mm stent with 16 atm; final kissing with two stent balloon.Provisional T stent Date7Date8Date9A morning 3 days later Date10Whats the problem in this re-occluded:Whats the problem in this re-occluded: 1 Stent in LAD ostium was under- expension? 2 Stents/thrombus in distal of LAD was not inflated first time? 3 other problems?Date11Date12