冠脉旋磨术适应证选择.ppt

冠脉旋磨术适应证的选择 为什么要选择冠脉旋磨术？ 如何选择适应证？ 冠脉旋磨术中需要注意的几个问题 时代不同了 During past few years, scope of PCI has advanced greatly, including several subsets: Complex, calcified lesions Very elderly patients (10% JGM PCI pts 80yrs) Patients with extensive comorbidity (CRF etc) turned down for CABG that provide resurgent role for Rotablator in improving procedural outcome. In 2006, 55 RA of 462 total PCIs (11.9%) Is there contemporary evidence to support this practice? ROCCSTAR Trial Randomisation Of Calcified Coronary Stenoses to TAxus stenting with or without Rotational atherectomy 132 patients – at least one moderate-severely calcified lesion on fluoroscopy Rotablation/DES vs DES alone Primary endpoint – 8 month binary angiographic restenosis Secondary endpoints – procedural success/MACE; acute/subacute/late stent thrombosis ROCCSTAR – recruitment to date 113 patients 57 Roto/DES 56 DES alone 34 large 23 small 34 large 22 small (3mm or ) 92% angiographic follow up ROCCSTAR – 2 observations to date reimpact of Rotablation on procedural outcome in calcified lesions In arriving at 56 pts in DES alone limb, of 64 pts intended for this limb, 8 (12.5%) unable to predilate fully (placed in ROCCSTAR Rotablator registry) Subacute stent thrombosis 2/56 (3.6%) in DES alone limb (both in small vessels) vs 0/57 in Roto/DES limb 冠脉旋磨术适应证的选择 为什么要选择冠脉旋磨术？ 如何选择适应证？ 冠脉旋磨术中需要注意的几个问题 Improve procedural outcomeExpand indications of PCI Balloon undilatable or uncrossable lesions, especially with superficial calcification Ostial lesions, particularly aorto-ostial stenosis Bifurcation lesions Long lesions 25 mm, especially with calcification Contraindications Thrombus-containing lesions Degenerated saphenous vein grafts Long lesions 25 mm FDA的建议 冠脉旋磨术适应证的选择 为什么要选择冠脉旋磨术？ 如何选择适应证？ 冠脉旋磨术中需要注意的几个问题 指引导管 / 磨头兼容性 Case 1 60 yrs, M? Smoking family history Hypertension 围手术期抗栓 ASA： 100 mg/day Clopidogrel： 300mg 6 hrs before UFH： 7000 I.U. during procedure Eptifibatide: Do