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急性 ST 段抬高型心肌梗死患者支架脱落后导致左主干和左旋支动脉夹层,我该如何处理?

How should I treat stent dislodgement in a STEMI patient resulting in dissection of left main and left circumflex arteries?

机构信息

National Heart Centre, Singapore, Singapore.

出版信息

EuroIntervention. 2013 Aug 22;9(4):527-31. doi: 10.4244/EIJV9I4A85.

Abstract

BACKGROUND

A 52-year-old female presented with acute anterior ST-elevation myocardial infarction (STEMI) within one hour of symptom onset to the emergency department. She was referred for urgent primary angioplasty.

INVESTIGATION

Physical examination, laboratory investigations, ECG, urgent percutaneous coronary intervention (PCI).

DIAGNOSIS

Single-vessel coronary artery disease (SVD).

TREATMENT

Intended to stent culprit lesion. However, stent dislodged in left main coronary artery (LMCA) during attempted PCI to diffuse mid segment of left anterior descending (LAD). Initial attempt failed to retrieve the dislodged stent with snare. Dislodged stent removed with multiple wire technique, complicated by severe dissection in LAD and left circumflex artery back into the LMCA. The stent was trapped at tip of 6 Fr right femoral sheath, unable to be withdrawn. What next?

摘要

背景

一名 52 岁女性在症状发作后 1 小时内到急诊科就诊,诊断为急性前壁 ST 段抬高型心肌梗死(STEMI)。她被转介进行紧急经皮冠状动脉介入治疗(PCI)。

检查

体格检查、实验室检查、心电图、紧急经皮冠状动脉介入治疗。

诊断

单支血管性冠状动脉疾病(SVD)。

治疗

打算支架置入罪犯病变。然而,在试图对左前降支(LAD)弥漫中段进行 PCI 时,支架在左主干冠状动脉(LMCA)内脱落。最初的尝试未能用圈套器取回脱落的支架。通过多根导丝技术取出脱落的支架,导致 LAD 和左回旋支严重夹层,并返回到 LMCA。支架被困在 6 Fr 右股鞘的尖端,无法撤出。接下来怎么办?

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