1. 2009 CIT CASE REVIEW Li Weijie Department of Cardiovascular Medicine, Xijing Hospital

2. Case 1 History (2009-3-21) Male, 55 years old Complain: Paroxysmal chest distress with palpitation for 3 years Aggravated for 3 months Past history: Hypertension Stents (Cypher) implantation at RCA 2-3 and 4PD (2008-12)

3. Diagnosis 1. Coronary artery disease Unstable angina pectoris Old inferior myocardial infarction NYHA class I 2. Stage 2 hypertension

4. ECG Old inferior myocardial infarction

5. Ultrasound Ejection Fraction 60%

6. Coronary angiography RCA2 25%; 4AV ostial 90%; RCA2-3, 4PD Free of in-stent restenosis

7. LAD6 99%; LAD7 100%; LCX12 80%; LCX13 25%; LCX15 50% Coronary angiography

8. LAD6 99%; LAD7 100%; LCX12 80%; LCX13 25%; LCX15 50% Coronary angiography

9. Collateral Circulation

10. Retrograde wire Runthrough Fielder Micro-catheter M3

11. Forward wire Fielder

12. Confirm the true luminal

13. Stents implantation 2.75mm×33mm FIREBIRD 3.0mm×23mm FIREBIRD

14. Coronary angiography

15. Follow up (2010-3-18) Complain: Mild chest distress UCG EF 55% ECG Old inferior myocardial infarction

16. Coronary angiography LAD6-8 Free of in-stent restenosis; LAD8 25%; LAD9 90%; LAD10 95%; LCX12 100%; LCX14 95%; LCX15 50%

17. Coronary angiography RCA1 25%; RCA2 25%; 4AV ostial 90%; RCA2-3, 4PD Free of in-stent restenosis

18. Balloon dilation 2.5mm×20mm

19. Stent implantation LCX13-14 2.75mm×29mm FIREBIRD2 14ATM 15s

20. Finall results Intramural hematoma

21. Case 2 History (2009-3-21) Male, 55 years old Complain: Paroxysmal chest distress with short of breath for 2 months Diagnosis: Coronary artery disease Unstable angina pectoris

22. ECG Sinus rate 76 bpm, normal ECG

23. Coronary angiography LMT 5 30%; LAD 6 ostial 90%; LAD 9 75% LCX OM3 50%; LCX 15 75%

24. Coronary angiography RCA 2 30%; RCA 3 50%; 4PD ostial 75%

25. Guiding 7F EBU 3.5 BMW Rinato Runthrough 2.5mm×29mm Firebird

26. Stent implantation LCX13-15-OM3 2.5mm×29mm Firebird 16ATM 7s 18ATM 7s

27. 2.5mm×13mm Firebird 2.0mm×20mm balloon

28. 3.5mm×23mm Firebird 2.0mm×20mm balloon

31. 3.5mm×20mm 10ATM 2.5mm×20mm 10ATM

33. Follow up Suesequent visit: the patient feel well, no complaint,no symptom Unwilling to subsequent CAG