罗建方_“拘禁”球囊分支保护技术.ppt

Side Branch Protection: Jailed Balloon Technique“拘禁”球囊分支保护技术 Luo Jianfang 罗建方 Guangdong General Hospital Do not loss SB !? Your Strategy? Two-stent T stent \ V stent \ Crush \ cullote \ dedicated stent? Provisional stenting ? Cross over and final kissing? Too small vessel ! Provisional stenting Stenting of the SB may be required in up to 51%. MB stenting can cause plaque shift, spasm, protrusion of the stent struts into the SB Changes in the bifurcation angle The jailed balloon technique(JBT) is a novel modified provisional stenting technique that aims to maintain SB patency and improve SB access. Jailed Balloon Technique Both limbs of the bifurcation are accessed with 0.014“ wire Predilatation of the MB with a standard semicompliant balloon Step 1 Step 2 3. A monorail balloon that is sized to approximate the SB vessel diameter (generally 1.5–2.0 mm and of adequate length) The proximal marker of the SB balloon is positioned approximately (0- 2 mm) proximal to the stent Step 3 Jailed Balloon Technique 4.The MB stent is deployed to nominal pressures, jailing the SB wire and balloon Step 4 Jailed Balloon Technique 5. If the SB has not been compromised (i.e., TIMI 3 flow), then the trapped SB balloon is inflated to low pressure( 6 ATMs) If there is less than TIMI 3 flow in the SB, routine balloon angioplasty is performed before the balloon and wire are removed Jailed Balloon Technique Step 5 Keep stent balloon initial position! 6. The MB stent balloon’s position is maintained carefully during SB balloon removal Jailed Balloon Technique Step 6 7. The stent balloon is then fully expanded to moderate or high pressure, optimization of MB stent apposition, and to correct any stent deformation as a result of the jailed-balloon inflation Jailed Balloon Technique Step 7 8. Final angiography will then reveal whether or not recrossing through the stent struts into the SB is necessary for provisional angioplasty and/or stenting. Jailed Balloon Technique