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The Core strategy of The Core strategy of the CAD Management the CAD Management Yu Jie Zhou, Yu Jie Zhou, MD, PhD, FACC, FSCAI, MD, PhD, FACC, FSCAI, FHRS FHRS Beijing An Zhen Hospital, Capital Beijing An Zhen Hospital, Capital Medical University, Beijing, China Medical University, Beijing, China 首首首首首首首首首首首首首首 首首首首首首首首首首首首首首

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Page 1: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

The Core strategy of the CAD The Core strategy of the CAD ManagementManagement

Yu Jie Zhou, Yu Jie Zhou, MD, PhD, FACC, FSCAI, MD, PhD, FACC, FSCAI, FHRSFHRS

Beijing An Zhen Hospital, Capital Medical Beijing An Zhen Hospital, Capital Medical University, Beijing, China University, Beijing, China 首都医科大学附属北京安贞医院首都医科大学附属北京安贞医院

Page 2: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Stent WarsStent Wars

1977-87

the mid-80's

Toulouse, Jacques Puel & Ulrich Sigwart first stent into a human coronary artery.1986

Palmaz-Schatz stent was approved for use in the United States.

1994

Close up again (30%)

Page 3: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

The DES Technology Explosion

Page 4: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 5: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

SVG angiographic patencySVG angiographic patency

Fitzgibbon GM, et al. JACC 1996;28:616-26.

Page 6: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

SVG PathologySVG Pathology

Page 7: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Worldwide PCI proceduresWorldwide PCI procedures

+2% per yr

Page 8: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

DES=“a ticking time

bomb” ?

However…

Page 9: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Coronary Aneurysm Coronary Aneurysm

Stent thrombosis Stent thrombosis

Stent fractureStent fracture

Problems with DES Problems with DES

Page 10: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Real-world data of DESRetrospective analysis of 94,384 consecutive stent implantations

from SCAAR registry, 2006-2008

Clinical Outcomes at 2 Years

European Heart Journal. 2012 Mar;33(5):606-13.

Page 11: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Drug-eluting stentsthe good, the bad, and the ugly !

The risk of bleeding is increased with DESThe risk of bleeding is increased with DES

Page 12: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Hybrid: the best of both worlds

27

10.7

2

16.4

26.1

0

5

10

15

20

25

30

BMS DES IMA SVG SVG

Eve

nt

rate

(%

)

BARI, SIRIUS, & PREVENT IV Trials

PRE

VE

NT

IV

Gra

ft o

cclu

sion

Page 13: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

HYBRID OR

Page 14: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Simultaneous vs. Staged Hybrid Simultaneous vs. Staged Hybrid ProceduresProcedures

Simultaneous: Simultaneous: • Pro: convenient and economical for patients • Con: issues with antithrombotics

– Timing and dosing of clopidogrel load?– Reverse heparin with protamine?

Staged:Staged:• Pro: not need hybrid operating room

– Surgery first avoids antithrombotic issues

• Con: When there is a tight lesion in non-LAD vessel– risk of stent thrombosis

Page 15: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Femoral

1988 CABG

2000PCI

2001PTCAICD

2010LVAD

2012Heart transplant

Page 16: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

1988 CABG

2000PCI

2001PTCAICD

2010LVAD

2012Heart transplant

Page 17: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

A patient of multifocal atherosclerosisA patient of multifocal atherosclerosis

Babunashvili. Presented at EuroPCR 2011

Page 18: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Can we stop this Can we stop this from the early from the early

beginning?beginning?

Page 19: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

A Heart With 67 StentsA Heart With 67 Stents

J. Am. Coll. Cardiol. 2010;56;1605

Iron manIron man

Page 20: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 21: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

To Stent Or Not To Stent, That To Stent Or Not To Stent, That Is In Question.Is In Question.

Page 22: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Real Life CardiologyReal Life CardiologyOculo-Stenotic-Reflex (Oculo-Stenotic-Reflex ( 眼球眼球 --狭窄反射）狭窄反射）

Page 23: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Evidence based PCI procedureEvidence based PCI procedureNovel techniques on the horizon… Novel techniques on the horizon…

Computational fluid dynamics (FFRct)Computational fluid dynamics (FFRct)

Page 24: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

In this large contemporary US cohort, nearly all acute PCIs

were classified as appropriate. For non-acute PCIs, however,

only 50% were classified as appropriate.

JAMA. 2011 Jul 6;306(1):53-61.

Reality is alarming!Reality is alarming!

Page 25: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Conclusion: Among patients with stable CAD

undergoing PCI, less than half were receiving OMT before PCI and approximately two-thirds

were receiving OMT at discharge following PCI.

JAMA. 2011 May 11;305(18):1882-9. OMT: Optimal Medical Therapy

Optimal Medical Therapy is Underused in US

Page 26: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Medical treatment for CVD remains markedly poor worldwide

PURE (Prospective Urban Rural Epidemiological) study

The Proportion of medications taken for secondary prevention

in CVD patients is

Remarkably Low !Remarkably Low !

Lancet 2011;378:1231–43

Page 27: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

The “dead end” road from promising scientific breakthrough to real-world

remedy

Page 28: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

The Core of CAD Management

Page 29: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

ACS动脉粥样硬化疾病的“冰山一角”

Page 30: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

认清本质，方能知道危险在哪里

Page 31: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

From dust you are and to dust you return! ——Holy Bible

From dust to dust!

Volcanic eruption, earthquake, tsunami

Oil

Blood vessel “rust”

Valcano——unstable

Lipid——AS Plaque

“Dust”学说 (生

锈 )

“Fire”学说（发

火）

“Oil”学说（原

油）

Page 32: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

动脉粥样硬化斑块的形成和发展

内皮损伤内皮损伤

单核细胞和 T淋巴细胞趋化单核细胞和 T淋巴细胞趋化

巨噬细胞吞噬氧化 LDL巨噬细胞吞噬氧化 LDL

脂纹，脂质斑块形成脂纹，脂质斑块形成

细胞黏附分子表达增加细胞黏附分子表达增加

炎性细胞进入内皮下炎性细胞进入内皮下

泡沫细胞形成泡沫细胞形成

Rust生锈

Fire发火

Oil进油

Page 33: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Essence of atherothrombosisEssence of atherothrombosis

Page 34: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Coronary Atherosclerosis Coronary Atherosclerosis Development Development

Page 35: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Vulnerable Plaque “ Active Volcano”Thrombotic effectACS

Calcified Plaque“ Dormant Volcano ”Hemodynamic effectStable Angina

Clinical Presentations of Coronary Disease

Page 36: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

AS进展期

稳定型心绞痛

斑块破裂

ACS猝死

破裂斑块修复

ACS后PCI/CABG术后

The man is as old as his arteries

Peter Libby, Circulation 2001;104;365-372

斑块形成

高血压合并促 AS因子

How to Turn Back the Clock When Your Blood Vessels Grow Old Before You Do. --------By Ron Winslow

Page 37: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 38: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI = dental procedure

Page 39: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

医疗医疗的双向性

病情病变的变化性治疗和经验的局限性患者的满意度的可变性

夸大的介入治疗的作用！

Page 40: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

医药费用知多少？10mg Rosuvastatin=9.28元

我国每天将花费 18.57亿元 /天

医保： 16.71亿元 /天 个人： 1.86亿元 /天

Page 41: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Male, 67 yoMale, 67 yoNSTE-ACS on admissionNSTE-ACS on admission

Risk factors:

Hypertension 14 yr

Prior ischemic stroke 14 yr

Heavy smoker

No DM history

Clinical History:

exertional angina 3 mo

exacerbated 10 hr

ECG: V1-V6, I, AVL ST

depression 0.1-0.25mV

TnI 9.66 ng/ml; N-BNP 2915 pg/

UCG: LV lateral, apex, anterior

dyskinesia. LVDD 60mm. EF

38%. Severe MR. moderate PH.

IMI

Page 42: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Frequent onset of resting chest pain

Page 43: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

However, at the cath lab…However, at the cath lab…

• Pts had acute LV failure: severe dyspnea, orthopnea… Pts had acute LV failure: severe dyspnea, orthopnea… • HR 120-150bpm, BP 180/100 mmHg dropped to 60/40mmHgHR 120-150bpm, BP 180/100 mmHg dropped to 60/40mmHg• Remained hemodynamically unstable despite inotropic Remained hemodynamically unstable despite inotropic

agents …agents …

• General anesthesia, mechanical ventilation & ECMOGeneral anesthesia, mechanical ventilation & ECMO• Guidewire of IABP cannot be advanced due to severe Guidewire of IABP cannot be advanced due to severe

stenosis of left femoral artery stenosis of left femoral artery

Page 44: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

AngiogramAngiogram July 28, 2010

Coronary Findings: LMd 99%, LADo 95% , D1 90%, LCXo 99%, LCXm 80%, RCAd

diffuse lesion.

Page 45: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

AngiogramAngiogram July 28, 2010

Coronary Findings: LMd 99%, LADo 95% , LCXo 99%, LCXm 80%, RCAd diffuse lesion.

Page 46: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• 6F EBU 3.5• 3 Runthrough in LAD, LCX,

D1, respectively

• 2.5mm*20mm Sprinter predilated LCX

PCI TransradialPCI Transradial

Page 47: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI TransradialPCI Transradial

• Deployed a 2.75*33mm Firebird at LCXm at 12 atmDeployed a 2.75*33mm Firebird at LCXm at 12 atm

Page 48: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• 2.5mm*20mm Sprinter predilated LADp

PCI TransradialPCI Transradial

Page 49: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI TransradialPCI Transradial

• Deployed a 3.0*23mm Firebird at LADp at 16 atmDeployed a 3.0*23mm Firebird at LADp at 16 atm

• 3.0*12mm NC Sprinter post dilation at 20 atm3.0*12mm NC Sprinter post dilation at 20 atm

Page 50: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Stent LM-LCX • 3.5mm*18mm Firebird

Page 51: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Stent LM-LAD • 3.5mm*29mm Firebird

Page 52: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Two 3.5mm*15mm Sequent NC at LAD, LCX

Page 53: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• After final Kissing

Page 54: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI TransradialPCI Transradial

• 6F JR 3.56F JR 3.5

• Predilation with 1.5*15mm & 2.5*20mm BCPredilation with 1.5*15mm & 2.5*20mm BC

Page 55: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI TransradialPCI Transradial

• Consecutively deployed 2.5*29mm , 3.0*29mm,& 3.5*33mm Consecutively deployed 2.5*29mm , 3.0*29mm,& 3.5*33mm

Firebird DES stentFirebird DES stent

Page 56: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

After procedure…After procedure…

• T 37.8 oC• WBC 19.7*109/L• N% 95%• IV antibotics –-

sulperazon• IV ambroxol HCI

28/7

Page 57: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• SaO2 dropped to < 90

• Although with frequent sputum aspiration

• X ray (10:41, 31/7)• Atelectasis

After procedure…After procedure…

Page 58: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Sputum aspiration by Bronchoscopy Sputum aspiration by Bronchoscopy

• 10:50, 31/7 • 14:52, 31/7

Page 59: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

After procedure…After procedure…

• Patient’s hemodynamic condition were stabilized 15 hr after having ECOM & PCI procedure

• Gradually reduced the volume of mechanical ventilation and ECMO

• Withdrew ECMO on 2nd Aug (5 days after procedure)

Page 60: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

However, 6 hours later…However, 6 hours later…

• BP 55-85/40-50mmHg, HR 150-160 bpm• Dopamine increased from 7 ug/Kg/min to 17

ug/Kg/min• Administrated inotropes, vasoactive agents… • Condition got worse…

• ECMO 2ECMO 2ndnd time time

Page 61: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

EchocardiogramEchocardiogram

DATE LV(EDD/ESD) LVEF%

28/7 Preprocedure 60/45 38 LV lateral, inferior, apex, anterior dyskinesia; Severe MR; moderate PH.

28/7 immediately after procedure

50 28

29/7 50/38 35

30/7 54 38

31/7 48*84 41 Moderate MR

1/8 50*80/42 45

Page 62: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Female, 57 yoFemale, 57 yoRecurrent angina for 10 daysRecurrent angina for 10 days

Risk factors:

No hypertension

No DM history

Med History:

PCI 6 months ago

LAD: 2.5*24 mm Resolute

& 3.0*36 mm Partner

Page 63: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

AngiogramAngiogram March, 2013

Coronary Findings: LMd 80%, LADo 80% , LCX (-),RCA (-).

CASE

Page 64: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Stent thrombosis?

• Intramural hematoma ?

• Neoatherosclerosis?

AngiogramAngiogram March, 2013

Coronary Findings: LMd 80%, LADo 80% , LCX (-),RCA (-).

CASE

Page 65: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Review previous PCI procedureReview previous PCI procedureAngiogramAngiogram Oct, 2012

Coronary Findings: LM (-), LADp 80% , LCX (-),RCA (-).

Page 66: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI Oct, 2012PCI Oct, 2012

• 6F EBU 3.5• BMW in LAD, S1

• 2.0mm*15mm Sprinter• 2.5*24 RESOLUTE

Page 67: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• 3.0*36 mm Partner •

Page 68: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• Unstable guiding catheter

Page 69: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Final results of 1Final results of 1stst PCI PCI

Page 70: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

ONLY 5 mo • Intramural hematoma ?• Stent thrombosis?• Neoatherosclerosis?

Page 71: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

PCI Mar, 2013PCI Mar, 2013

• 6F EBU 3.5• BMW in LAD, LCX

• 2.5mm*20mm Sprinter

Page 72: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 73: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• 4.0*23 mm XIENCE V

Page 74: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 75: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

• 4.5*15 mm NC SPRINTER

Page 76: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院
Page 77: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Final results of 2Final results of 2ndnd PCI PCI

Page 78: The Core strategy of the CAD Management Yu Jie Zhou, MD, PhD, FACC, FSCAI, FHRS Beijing An Zhen Hospital, Capital Medical University, Beijing, China 首都医科大学附属北京安贞医院

Tsinghua in Beijing Chen Zhou Aug, 2003. Beijing

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