分叉病变PCI术中边支球囊保护技术应用.ppt

分叉病变PCI术中边支球囊保护技术应用 哈医大四院心脏中心 夏洪远 李学奇 简述 冠状动脉粥样硬化最易发生于分叉部位 分叉病变约占PCI的15-20% 常见的分叉病变有LM-LAD-LCX、LAD-D1、LCX-OM1 、 RCA-PDA 分叉病变PCI具有挑战性，是每位心脏介入医生必修的本领 分叉病变的难点在于导丝的操作 主支支架置入后的边支导丝再进入成为能否成功保留边支的技术关键 “保护”导丝 保护导丝技术，只有配合球囊保护技术，可以将边支的保护做到最大化 单纯“保护”导丝，在边支血管闭塞或严重狭窄情况下，只能起到“路标”的作用 如果边支再进入导丝困难，甚至导丝进入夹层，可能导致边支PCI功败垂成 较粗大边支血管闭塞，患者会出现缺血症状，甚至血流动力学不稳定 导丝无法再次进入 导丝进入夹层---边支闭塞 结果不佳 进退维谷，锦囊妙计 提高导丝操作技巧固然重要 即使技艺再高超，也会遇到导丝无法再次进入边支的病例 策略比技术更重要 球囊保护技术可以简化导丝的操作 Jailed balloon protection: a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience--- EuroIntervention. 2010 Feb;5(7):809-13:Burzotta F, Trani C, Sianos G AIMS Provisional stenting with drug-eluting-stents is actually adopted to treat most of bifurcated lesions. A major drawback of this technique is the risk of side-branch (SB) closure after main vessel (MV) stenting METHODS AND RESULTS The uninflated balloon, which remains jailed under the stent struts, serves to reduce both carina and plaque shifts due to its SB ostium spatial occupation If SB flow is preserved after MV stenting, the jailed balloon is removed uninflated If the SB becomes occluded after MV stenting, the jailed balloon may either be used as a marker and a favourable angle modifier to facilitate rewiring or can be dilated to try to restore SB flow SB rewiring and kissing balloon inflation must be performed to correct stent deformation or malapposition This novel technique has been successfully adopted in 20 patients with complex (55% unprotected left main, 85% Medina 1,1,1 lesions) true bifurcated lesions undergoing drug-eluting-stent implantation. CONCLUSIONS The jailed balloon protection is a novel technique aimed at improving SB protection during provisional stenting of bifurcated lesions considered at high risk of SB compromise after MV stenting 球囊保护技术 灵活应用边支球囊，保护边支血管，称之为“球囊保护技术” 包括预埋球囊和掘进球囊技术 边支血管闭塞时，球囊保护技术尤为重要 何谓“球囊保护”技术 预埋球囊方式： 主支或分支 浅埋或深埋 球囊掘进方式