CTO介入治疗中的常见问题.pptVIP

* * * * * 缺乏必要的器械 器械辅助如虎添翼； 在良好的CTO介入技术的基础上，如要进一步突破，需必要的器械辅助 IVUS/特殊导管 既要重视，又不应过分强调。 * CTO介入治疗：我们存在的问题 对现代CTO介入技术缺乏系统了解 对影像学资料收集不够准确 缺乏周密手术计划 不重视对侧造影的重要性 不会应用平行导丝（双导丝）技术 重视“手感”、轻视“方向” 对进入假腔缺乏判断 术中没有保持足够的警觉 缺乏必要的器械 对逆向技术不够重视/不掌握 * CTO介入策略 CTO 顺向 逆向 对侧造影 单导丝 平行导丝 逆向扩张 对吻导丝 CART/Knuckle导丝 IVUS/螺旋CT引导 * 如何成为“高手” 目前CTO病变介入治疗已趋向成熟，对不同情况的处理已形成套路，应系统学习； 知识和策略比技术更重要； 注重术前资料收集和计划制定； 掌握和应用有效技术 对侧造影、双导丝技术、逆向技术等 培养高手素质 谨慎、忍耐、冷静、善思、耐心、警醒、善于总结、好学… * CTO介入并发症的防治 Complication is the things you don’t ever want to be in the room for. Try every effort to reduce complication. How to avoid complication should be taken into consideration when we plan the procedure. During Procedure -monitoring ECG -monitoring BP -check ACT(300)once a hour * Reversal of heparin -1mg of protamine for every 25 units of heparin given in the previous 4 hours -maximum 25-50mg -IV over 10-30min until ACT150 sec. Prolong balloon inflation @ low pressure for 15min or much more. Pericardiocentesis Cover stent Distal micro embolization -coil or fat tissue -blood clot? -aspiration from micro catheter at the wedge position close to perforation site How to manage perforation * Dissection of a collateral pathway Perforation of a collateral channel -hematoma -perforate into a ventricle -pericardial effusion/cardiac temponade Donor artery ischemia cause by -deep engage GC -proximal vessel disease -dissection -thrombosis Complications associate with retrograde approach * Check the position of GC keep BP monitoring Check ACT once a hour Frequent flush the GC Stent the borderline lesions in the proximal segment of donor artery How to prevent acute obstruction in the donor vessels Donor vessel obstruction may lead to critical condition * Myocardial Ischemia -collateral branch damage -spasm Aortoiliac -aortic root dissection -perforation of the sinus -peripheral hematoma bleeding Device -guide