慢性完全性闭塞病变的病情介绍：重要概念和技术-英文.ppt

LAD: Cranial view LAD: RAO view First Wire Second Wire Second Wire: position A Second Wire: position B Second Wire: position B Second Wire: position A Distal fibrous cap First Wire Second Wire Sub-intimal space Sub-intimal space Parallel Guidewire Technique modified; Tsuchikane et al, 2007 Second wire: stiff, tapered wire Septal Br. Diagnal Br. Septal Br. Diagnal Br. Parallel guidewire technique:Advantage Avoid 2nd guidewire advance into the sub- intimal space made by 1st guidewire Avoid more dilation of sub-intimal space made by 1st guidewire Landmark for guidewire handling Less use of contrast agent Change the geometry of lesions or vessel O.T 64 y.o EAP Control angiography: Cx CTO O.T 64 y.o EAP PCI: Cx CTO O.T 64 y.o EAP IVUS after first wiring O.T 64 y.o EAP IVUS guided wiring Guidewire: Conquest pro IVUS cathether O.T 64 y.o EAP After re-wiring RAO view Guiding cathether:Brite tip 7F JL4 (Cordis- Miami US; Rt. transfemoral) Contralateral angiography:HT-HAYASHI 5F (L-R)(Goodtec; Lt. transradial) Retrograde approach : LAD ostial CTO LAD LCx LMT Guidewires　[Miracle primo(2.5g), Conquest （Confianza) Pro (9g；) :Asahi Intecc, Proneur ST(9g):Zeon] could not be placed the entry of CTO lesion with IVUS guidance. Retrograde approach S.K 67 y.o EAP IVUS Guidewire:GW at high lateral branch LAD ostial LCx Distal tip of the wire support catheter Septal vessels Guidewire (GW) at LAD Runthrough NS (floppy) Retrograde Wiring Guiding cathether: XB RCA 6F(Lt. Transradial:Cordis) Guidewire: Runthrough NS floppy (1ｇ：Terumo) - Hydrophilic wire Wire support cathether - RapidTransit (Cordis) 150cm S.K 67 y.o EAP POBA and Stenting After ballooning (1.5mm:Ryujin Plus;Terumo, 1.25mm, 2.5mm :VENT speeder; INVATec), two long (3.0mm*33mm) Sirolimus eluting stents (Cypher; Cordis) were implanted. Final angiography (Post SES stenting) S.K 67 y.o EAP CTO : Strategy of procedure Antegrade approach Retrogrde approach First guidewire Second guidewire Pararell wire techn