左主干病变pci中ivus的指导作用：是否必需？.ppt

造影有局限性 IVUS Predictors of the Events Angiographic Predictors of the Events THANK YOU ! Using IVUS, most LM lesions show either insignificant disease or critical disease Absolute lumen CSA 6.0mm2 (or MLD 3.0mm) – independent of plaque burden - is the suggested criterion for a significant LMCA stenosis Correlates with a LMCA FFR0.75 Murray’s Law (LMCAr3 = LADr3 + LCXr3) Does not depend on finding a disease-free reference segment The best available data indicates that IVUS-guidance during LM DES implantation will reduce 3-year mortality; the final MSA should be 8.5mm2 to minimize TLR. Summary Is IVUS guidance necessary for the optimal diagnosis and treatment of left main lesions? Given all of this data, the known limitations of angiography, and the risks of making a mistake, how can you possibly argue otherwise? Conclusion * * * * * * * This figure demonstrates relationship between MLD and probability of cardiac events. For example, event rates in patients with an MLD of 3 mm or greater and no DM or no untreated vessel was only 3%. However, the event rates was significantly higher in the presence of DM and untreated vessel 50%. * * 1、短而没有参照 2、造影剂反流影响开口判断 3、层流导致假阳性狭窄 4、弥漫病变低谷支架大小 5、是否需要使用切割技术 6、钙化和旋磨是否使用 7、治疗策略的选择 This situation is rather a common problem that based on angiography the patient has undergone unnecessary CABG, but IVUS letter on has demonstrated that LMCA stenosis is not significant. When you encounter the LMCA stenosis as demonstrated in the figure, Don’t Panic: Just IVUS IT. All IVUS parameters predicted the event rates during the follow-up. Among those, MLD was the strongest predictor of the event rate. The bar graft in red demonstrates the events and in yellow demonstrates no events On the other hand, angiographic data including MLD and DS did not predict the events. ROC curves demonstrated that FFR predicted IVUS MLD and IVUS MLA with a strong sensitivity and specificity. In contrast, the predictive accuracy of FFR for area stenosis by QCA was mode