International Circulation: How would you assess the unresolved problems in interventional therapy of ACS at present?

《国际循环》：目前介入治疗针对ACS还未解决的问题您是怎么看的？

Prof. Kleber: We have solved so many problems in acute coronary syndrome. We have improved outcomes a lot， but we have still not resolved all problems. One of the problems we are about to solve now， is the problem of thrombus burden in coronary arteries. They are very difficult to see on angiography. If you compare it to the carotid arteries， in acute ischemia of the carotid arteries， the surgeons and people who stent these， are aware there are a lot of thrombi and we always thought earlier that in coronary arteries， there are no thrombi because the heart is moving a lot， but now we realize that in a considerable proportion of patients with acute MI there is a huge thrombus load.

Kleber教授: 我们已经解决了ACS很多问题。我们有很多更好的成果，但我们还没有解决所有问题。我们现在要解决的一个问题是冠状动脉血栓负荷问题。在血管造影下很难看到这些血栓。与颈动脉栓塞相比，颈动脉急性栓塞缺血时，外科医生和介入科医生看到了许多血栓。早期我们认为，因为心脏运动剧烈，冠状动脉内没有血栓，但现在我们认识到，在一些急性心肌梗死患者有相当大的比例是大的血栓负荷引起的。

International Circulation: How do you deal with angiographically evident thrombi in acute myocardial infarction? Is it necessary to use distal embolic protection devices in emergency PCI?

《国际循环》：在急性心肌梗死行血管造影情况下见到血栓您如何处理？是否有必要在急诊PCI使用远端血栓保护装置?

Prof. Kleber: The distal protection devices that are useful and helpful in bypass PCI are not helpful in acute MI. We don’t know the exact reason. What is helpful is to get rid of the thrombus with aspiration catheters. There are many types of aspiration catheters available on the market but not all of them have had really large trials. But there are large trials that show that the benefit is very large and the relative reduction in mortality is about one third. So if you say hospital mortality for acute MI is currently at 6% and can go down to 4 or 3.5% with aspiration catheters， then it is something that has to be considered in any case. I don’t think we have to do it in every AMI， but we have to do it if we don’t have a good flow after passing the wire through the occluded part.

Kleber教授:对于旁路PCI来说远端保护装置是有用的，对于急性心肌梗死没有什么用。我们不知道确切的原因。我们可以使用抽吸导管来去除这些血栓。市面上有许多类型的抽吸导管，但不是所有导管都做过大型临床试验。有大型试验表明这些导管很有用处，死亡率相对减少约三分之一。因此，如果医院急性心肌梗死死亡率目前为6％，通过抽吸导管可以减少死亡率到4%或3.5％，那么这件事情就不得不考虑了。我不认为每一例急性心肌梗死患者我们都应该这么做。但如果我们使用导丝通过闭塞部分后仍旧没有获得良好血流的话，我们必须使用抽吸导管。

International Circulation: What is your opinion on interventional therapy for LMT?

《国际循环》：请谈谈您对左主干病变（LMT）介入治疗的意见？

Prof. Kleber: We currently treat a lot of left main diseases and I see no good reason why not to treat left main. We do know the guidelines still say this is a surgical domain but it is not more difficult to treat left main lesions. We have very good drugs and the anti-thrombotic drug therapy is still improving. We have new oral drugs and we have new IV and subcutaneous drugs now available. It is time to treat left main with a catheter.

Kleber教授:目前，我们治疗了很多左主干疾病，我认为没有很好的理由不去处理左主干病变。我们知道指南上说左主干病变属于外科手术领域，但介入治疗左主干病变并不难。我们有很好的药物，而且抗血栓治疗药物还在不断改进。我们有新的口服药物，静脉药物，皮下注射药物可以选择。现在是导管介入治疗左主干病变的时候了。

International Circulation: In the primary PCI for ACS patients， how can the new anticoagulant agent fondaparinux， be used in this area?

《国际循环》：ACS患者行PCI术时，新型抗凝药磺达肝癸钠如何使用？

Prof. Kleber: There are several new anti-thrombotic drugs that are coming up and not all are approved for the use in acute coronary syndromes and certainly not all are comparable to each other. At the moment I would not be saying this one is good and this one is not as good but will watch the development of the scientific trials. But there is progress in this area.

Kleber教授:有一些新的抗血栓药物出现，不是所有药物都适合使用在急性冠状动脉综合征上，当然相互之间也没有比较。现在，我不会说哪个好哪个不好，我需要看科学试验的进展。但是，这一领域确实在进步。