ffr 临床应用 PPT.ppt

What can be learned and achieved from “FFR-guided PCI”?; FFR=;冠脉;正常值 FFR = 1.0;是否具有临床意义？;FFR 压力导丝的临床应用;Where can we use pressure wire?;临界病变;VA 10.2mm2 LA 7.4mm2 Plaque Burden 27.0% ;VA 10.49mm2 LA 2.54mm2 Plaque Burden 75.7% ;;Pijl NH, JACC 2007;49:2105 ;50-70%狭窄：仅凭造影会有35%的缺血病人被忽略治疗。 70%狭窄：仅凭造影会有20%的没有缺血的病人被过度治疗;Nam CW, et al. JACC interv 2010:3:812;Where can we use pressure wire?; ; ; ; ; ; ; ; ; ;FFR 0.87;在造影认为的3支病变中，经FFR测量 14% 是 3-VD ????????? 43% 是 2-VD ????????? 34% 是 1-VD ???????? 9% 是 0-VD ?;多支病变FFR的应用 ;Where can we use pressure wire?;0.70; 在最大充血状态下进行PULL-BACK 1、把导丝放置于病变冠脉的远端。 2、静脉连续滴注ATP或腺苷，诱导最大充血状态。 3、如果FFR0.8，则串联病变可诱发缺血，PCI是合适的。 4、在透视状态缓慢回撤导丝，发现有突然压力改变的点或节段。如果局部压力阶差≥10mmHg，可以考虑在这个部位放置支架。 5、优先处理压力阶差大的病变，如果病变压力相似，优先处理远端病变。 ; 在最大充血状态下进行PULL-BACK 6、最严重的病变放置支架后，需要再次做PULLBACK， 需要理解的一点，在最严重的病变放完支架，与术前比， 其他病变的压力阶差会上升。 重要规律：一个严重的远端病变可以掩盖近端病变的压力阶差，反之亦然。 ;1;Where can we use pressure wire?;弥漫长病变;How to Distinguish Focal from Diffuse ?;Hennico Walter 85621;Sensor Left in Distal LAD;Hennico Walter 85621;Hennico Walter 85621;压力的测量和弥漫病变 ;弥漫病变压力测量 ;Pressure Measurements in Diffuse Disease ;Multiple stenoses and diffuse disease: In some patients, focal or segmental pressure drops can be detected and stenting in the right way is beneficial, like in the patient above. Sometimes, however, there are no focal or segmental pressure drops, but decline of pressure is homogeneously distributed all along the artery,In such cases, PCI is not possible and has no sense and stenting is only a cosmetic Treatment.;Where can we use pressure wire?;左主干开口狭窄;;开口和??主干病变 ;左主干狭窄 ;213 patients with angiographically equivocal LM CAD;左主干狭窄的评估;Where can we use pressure wire?;Various size, various amount of supplying myocardium Side branch ostial lesion is unique Underlying plaque ? Eccentric plaque Remodeling ? Negative remodeling Mechanisms of luminal narrowing Carina shift, plaque shift, stent struts, thromb