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病例分享：男性，68岁，陈旧下壁 前壁心肌梗死

2021-04-23 网络 网络

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作者琴心剑胆

作者琴心剑胆 泰医附院高医生

男性，68岁，陈旧下壁 前壁心肌梗死，2020.2 2020.8 于LCX,LAD共植入支架三枚。

 

造影结果

 

拟开通RCA

双侧造影

读图： RCA闭塞钝形头端，闭塞端锐缘支发出，闭塞长度10-20mm。难点：开口不明确。

策略：先正向尝试，失败转换逆向。

【正向】先尝试正向，SAL.75+130cm Finecross +fielder XT，入口不明确，系统支撑力差，XT没有着力点，尝试十分钟，换用Gaia2导丝，内膜下。改变策略。

【逆向】间隔支S2→RCA CC 2级。选择sion+150cm Finecross MG 小心操作穿前降支网眼通过侧枝，并进入闭塞段内，微导管无法跟进。停止逆向导丝操作。

【KWC】逆向导丝做marker，再次尝试正向，Gaia2，耐心调整至PLA，验证真腔后，微导管无法跟进，1.5→2.0球囊扩张，锐缘支导丝保护，由远到近串联支架四枚→检查侧枝无损伤→结束手术。

 

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1008576, encodeId=b7a510085e629, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210115/3496e0581a8a4aec93961012392656e4/fd1698e580a54f3caacf567878f77f53.jpg, createdBy=dd5a5211014, createdName=unlobotomy, createdTime=Tue Aug 17 08:49:28 CST 2021, time=2021-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960809, encodeId=1fdf960809ca, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Mon Apr 26 23:52:02 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959923, encodeId=c6d395992355, content=这个的确第一次见, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18df2566800, createdName=妙酒, createdTime=Fri Apr 23 23:45:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959884, encodeId=77629598847c, content=感谢老师分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Fri Apr 23 21:51:57 CST 2021, time=2021-04-23, status=1, ipAttribution=)]
    2021-08-17 unlobotomy

    #病例分享#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1008576, encodeId=b7a510085e629, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210115/3496e0581a8a4aec93961012392656e4/fd1698e580a54f3caacf567878f77f53.jpg, createdBy=dd5a5211014, createdName=unlobotomy, createdTime=Tue Aug 17 08:49:28 CST 2021, time=2021-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960809, encodeId=1fdf960809ca, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Mon Apr 26 23:52:02 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959923, encodeId=c6d395992355, content=这个的确第一次见, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18df2566800, createdName=妙酒, createdTime=Fri Apr 23 23:45:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959884, encodeId=77629598847c, content=感谢老师分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Fri Apr 23 21:51:57 CST 2021, time=2021-04-23, status=1, ipAttribution=)]
    2021-04-26 MedSciZeng

    #病例分享#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1008576, encodeId=b7a510085e629, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210115/3496e0581a8a4aec93961012392656e4/fd1698e580a54f3caacf567878f77f53.jpg, createdBy=dd5a5211014, createdName=unlobotomy, createdTime=Tue Aug 17 08:49:28 CST 2021, time=2021-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960809, encodeId=1fdf960809ca, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Mon Apr 26 23:52:02 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959923, encodeId=c6d395992355, content=这个的确第一次见, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18df2566800, createdName=妙酒, createdTime=Fri Apr 23 23:45:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959884, encodeId=77629598847c, content=感谢老师分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Fri Apr 23 21:51:57 CST 2021, time=2021-04-23, status=1, ipAttribution=)]
    2021-04-23 妙酒

    这个的确第一次见

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1008576, encodeId=b7a510085e629, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210115/3496e0581a8a4aec93961012392656e4/fd1698e580a54f3caacf567878f77f53.jpg, createdBy=dd5a5211014, createdName=unlobotomy, createdTime=Tue Aug 17 08:49:28 CST 2021, time=2021-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960809, encodeId=1fdf960809ca, content=<a href='/topic/show?id=635be07725c' target=_blank style='color:#2F92EE;'>#病例分享#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70772, encryptionId=635be07725c, topicName=病例分享)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Mon Apr 26 23:52:02 CST 2021, time=2021-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959923, encodeId=c6d395992355, content=这个的确第一次见, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18df2566800, createdName=妙酒, createdTime=Fri Apr 23 23:45:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959884, encodeId=77629598847c, content=感谢老师分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20221103/2796e00c9b4549e3b313ed9e7accc68f/b52d6d98bbe04782b5a4e2dd1ee80be2.jpeg, createdBy=078e1614372, createdName=MedSciZeng, createdTime=Fri Apr 23 21:51:57 CST 2021, time=2021-04-23, status=1, ipAttribution=)]
    2021-04-23 MedSciZeng

    感谢老师分享

    0