《INTERNATIONAL CIRCULATION》:For the ACS， the ruptured plaque is the major reason and what would you do when you face heavy thrombosis in emergency PCI procedure?

Dr.John Calver:My opinion is to us IIB/IIIA inhibitor. First I will use LMWH and plavix and some adjunctive therapy and if patient is still sympotomatic， I will not hesitate to use IIb/IIIa inhitibor. Even patient is not unstable， the preoperative use of IIb/IIIa inhibitor will bring good outcome. During the procedure， if I find some evidence of no-reflow， thombosis etc， I will use IIb/IIIa for another 36 hours.

《INTERNATIONAL CIRCULATION》:If you do not find a sever stenosis after thorombs extraction， would you still use stent in ACS patients?

Dr.John Calver:Absolutely， we put stent. The only question for us is DES or BMS that depends on paient age， diameter of the vessel， lesion length. During the procedure， you will use ballooning， and that will cause some dissection that is not shown in coronary angigraphy. so I will put stent in anyway.

《INTERNATIONAL CIRCULATION》:If you find the thombosis is not organized， will you go stenting?

Dr.John Calver:If the above phenomenon happened， I will wait and repeat CA 24-36 hours later and maybe at that time， the thombosis is stable， so in summary， if you use good anticoagulation in advance， no reflow is low in PCI.

《INTERNATIONAL CIRCULATION》:In the start of this year， the New England Journal published OAT trial， would you give your opinion on this issue?
Dr.John Calver:You know， optimal medication is undoubtfully the base for any aggressive intervene. And many trials did not pay attention at life quality and during the clinical practice the patient complained angina if you do not use catheterization. Meanwhile， many trials had many bias which will influence the result.