分叉病变介入治疗我的.ppt

ContentDefinitionofbifurcationlesionClassificationofbifurcationlesionStrategyofbifurcation---onestentortwostentsSpecificstentforbifurcationClinicalcases

definition累及到冠状动脉分叉的病变冠状动脉病变中分叉病变较为常见，约占经皮冠状动脉介入治疗(pereutaneouscoronaryintervention，PCI)的15％~20％分叉病变的解剖结构(斑块负荷、斑块位置、血管角度、血管直径、分叉位置)千变万化．而治疗过程中解剖结构也会随时改变(斑块迁移、血管夹层)所以无两个完全一致的分叉病变，更无一种可适用于所有分叉病变的手术方法

Classification

ClassificationofbifurcationlesionsaccordingtoplaqueburdenA:DukeB:SanbornC:SafianD:Lefevre

MedinaA.etal.RevEspCardiol.2006;59:183-4ANewClassificationofCoronaryBifurcationLesions-MedinaClassification1,1,11,1,01,0,10,1,11,0,00,1,00,0,1MBDistalMBProximalSB

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(especiallyMI/thrombosis)分叉病变介入治疗

-关注热点

Stentingforbifurcationlesionsin2007主支放支架，分支临时决定Stentingthemainvesselwithprovisionalstentingofthesidebranch

ProvisionalStentingStrategy

If2ndstentisneededforsidebranchfollowingmainvesselstentingModifiedT-stentingReversecrushing Culottestenting

分支血管的保护与放置支架并非所有分支血管同等重要!根据以下情况实施分支血管保护和支架植入分支血管大小与分布区域分支血管开口病变与病变程度分支与主支成角程度

SidebranchclosureafterPCI

Side-branchmaybecompromisedfollowingmainvesselstentingPre-treatmentAfterstentingPlaqueshifting(“Snow-plow”)OstialspasmorSide-branchcompromisebystentmaterialDissectionofplaqueatoriginofside-branchDissectionflapatmainarteryobstructingoriginofside-branchAttimes,thesidebranchcouldbecompromisedbythrombustoo

DifferenttechniquesoftwostentsbyintentiontotreatbifurcationlesionsTheVstentingtechniqueThesimultaneouskissingstentstechniqueTheTstentingandmodifiedTstentingtechniqueThecrushtechnique(Thereversecrushtechnique/Thestepcrushtechnique/Theinvertedcrushtechnique)TheculottesstentingtechniqueTheYstentingtechniqueTheskirttechnique

TheVstentingtechnique

Thesimultaneouskissingstentstechnique

TheVstentingandthesimultaneouski