A AMI PATIENT WITH VERY VERY LATE THROMBOSIS IN THE STENT1DEPARTMENT OF CARDIOLOGY OF GENERAL HOSPITAL OF CHINESE PEOPLES ARMED POLICE FORCESYANG SHENGLI

Clinical manifestationPatient CHEN YANGBAO, male, 82 years oldThere are sevent years after AMI with PCI, Chest pain for 3 hours admitted to WJ GENERAL HOSPITAL at 10:30AM 30/04/2012History/Risk factors: Hypertension Smoking for 30 years. NO history of Diabetes mellitus.2005 PCILADd,m,p implanted stents with Firebird2.5*23mm3.0*33mm3.0*29mm, LCXp implanted stent with Firebird 3.0*23mm. Regular oral Aspirin 100mg QdPlavix 75mg Qd for one year.CREATININE 92umol/L; eGFR: 73ml/min/1.73m2

2009-11-3

2012-4-30 1230BP130/70mmHg

2012-4-30 1300

Emergency PCI2012-4-30 1:10PM

6F XBLAD GCPT2 LS GW into LADd

DIVER CE to LADpfailed pass stent in LADp

After thrombus aspiration

Runthrough GW to LCXdDIVER CE failed to LCX stent

After thrombus aspiration

Voyager 2.5 *15mm-----LCX

Voyager 3.0*15mm----LCX

LCX-PTCA

Voyager 2.0*12mm----LAD

2012-4-30 1610

2012-5-2 1410

2012-5-8 1455

Biomarker change

CKMBNormal range 0-4.3ng/mlMYONormal range0-107ng/mTNINormal range0-0.4ng/m

2012-4-30>80488>302012-5-14.910914.2

Drug treatment:Aspirin 100mg qdPlavix 75mg qdTirofiban 10ug/kg10mliv0.15ug/kg/min6ml/h3 days.LWFH 40mg Q12hAtovastatin 20mg qd

CAG+PCI2012-5-10

6F XBLAD3.5; BMW

VOYAGER NC2.5*15mm------LAD

VOYAGER NC2.75*15mm----LAD

VOYAGER NC3.0*20mm

VOYAGER NC3.0*20mm--LADp

XIENCEV3.5*18mm-----LADp

VOYAGER NC3.5*15mm

Runthrough

VOYAGER NC2.0*15mm

DiscussionIs this is a very very late stent thrombosis?If yes, Cause of stent thrombosis? Stent Underexpansion?How to treat this patient with PCI? Is the Strategy right? First PCI and second PCI? How long to use ADP recepter blocker?IABP ?IVUS ?Is the stent implanted right? Is the Ostial of LCX POBA right?

THANKS

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