严重钙化病变的pci治疗王海昌p36fturp.ppt

Case2：Severe Calcification and Balloon Suboptimal Dilation lead to Acute Stent Thrombosis Male ，57yrs Smoking 30yrs， Chest pain 3yrs， Rest ECG：V1-V3 lead ST segment depression0.1mv Cadiac Triponin T(-) Severe Calcification Baloon dilation Stenting Case2：Severe Calcification and Baloon Suboptimal Dilation lead to Acute Stent Thrombosis 4 days later!!! Female，76yrs Exertional chest pain 8yrs, recurrent 10days EF:40% RCA1:50％，RCA3:75％ LAD6：75％,7段90 with severe calcification， 8:50％，9:50％； LCX13:100％,14:25%,15: 50％ Case3： Rotational Atherectomy for Severe Calcification Cutting Balloon: 2.5*10 (16ATM, 20) Post dilate balloon: 2.5＊13 (18ATM, 12) Case3： Rotational Atherectomy for Severe Calcification Guiding ： 6F EBU3.5Guide Wire： Stablizer/ PT2MS Bur: 1.5mm Rotor rate ： 160000 rpm Case3： Rotational Atherectomy for Severe Calcification 2.5＊24 TAXUS(10ATM, 8) 2.75＊28 TAXUS(12ATM, 7) Final CAG Stenting 钙化病变的器械选择（I） 导引导管： 强支撑力 导引导丝：亲水涂层导丝， 支撑力 好， 采用微导管交换钢丝 球囊和支架通过性好 钙化病变的器械选择（II） 支架 建议选择设计有桥连接的支架 设计良好的管状支架，闭环系统、辐射力好、金属覆 盖率好。能够使支架更合理扩张、血栓率低、再狭窄 率低 旋磨头 依据血管直径，从小到大更换，最大旋磨头应 选择直径小于血管直径的75％。 钙化病变的操作要点（I） 预扩张：非常重要！ 支架往往不能直接通过病变；支架直接植入常会 导致支架不能充分扩张 球囊扩张 选择比血管直径小0.5mm以上的半顺应性、耐高压 球囊，扩张压在8atm以上，逐渐增加压力，直至 球囊切迹消失 切割球囊的使用 小样本研究显示，明显钙化病变的切割球囊治疗安 全有效 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 Trial (Randomisation Of Calcified Coronary Stenoses to TAxus stenting with or without Rotational atherectomy) Observations to date re impact 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%)