分叉病变介入的技巧.ppt

分叉病变介入技巧广东省人民医院谭 宁;Classification of bifurcation lesions according to plaque burden;Medina A. et al. Rev Esp Cardiol. 2006; 59: 183-4;一个好还是两个好？ 如果选２个，应该采取何种策略 ? 策略选择的根据 简单化 vs 复杂化 循证结果 vs 个人选择 并发症率 (especially MI / thrombosis) ;Stenting for bifurcation lesions in 2007;Provisional Stenting Strategy;分支血管的保护与放置支架;Side branch closure after PCI;Side-branch may be compromised following main vessel stenting;Different techniques of two stents by intention to treat bifurcation lesions;The V stenting technique;The simultaneous kissing stents technique;The V stenting and the simultaneous kissing stenting technique;The V stenting and the simultaneous kissing stenting technique;The V stenting and the simultaneous kissing stenting technique;The T stenting technique;The modified T stenting technique;The T and modified T stenting technique;Colombo et al Circulation 2004; 109:1244-1249;RESEARCH bifurcation subgroup;V stenting vs T stenting;Provisional T stenting;优点: Higher procedural success rate Lower expense Lower complications Lower re-PCI 7mons TLR 15%。 Lefevre et al: Provisional T stenting is the golden standard to treat false bifurcation lesion(tpye2, 3 and 4a), most subjects only need one stent implantation。;The crush technique;The crush technique;;6 mons RR Colombo et al. ;The reverse crush or internal crush technique;The reverse crush or internal crush technique;The reverse crush or internal crush technique;The step crush technique;Case: The step crush technique;;First kissing;;Second kissing;Final result;The step crush technique;The inverted crush technique;The inverted crush technique;Restenosis in MV = 12.2% Restenosis in SB = 2%;The culottes stenting technique;The culottes stenting technique;Nordic Bifurcation Study II - The Nordic Stent Technique Study : Crush vs Culotte stenting;Nordic Bifurcation Study II - The Nordic Stent Technique Study : Crush vs Culotte stenting;The Y stenting technique;The skirt technique;The Y stenting technique and The ski