高煒北京大学第三医院.pptVIP

* * * * This is the Bulleted List slide. To create this particular slide, click the NEW SLIDE button on your toolbar and choose the BULLETED LIST format. (Top row, second from left) The Sub-Heading and footnote will not appear when you insert a new slide. If you need either one, copy and paste it from the sample slide. If you choose not to use a Sub-Heading, let us know when you hand in your presentation for clean-up and we’ll adjust where the bullets begin on your master page. Also, be sure to insert the presentation title onto the BULLETED LIST MASTER as follows: Choose View / Master / Slide Master from your menu. Select the text at the bottom of the slide and type in a short version of your presentation title. Click the SLIDE VIEW button in the lower left hand part of your screen to return to the slide show. (Small white rectangle) * * * * Right coronary artery was no significant stenosis. As shown in this Angiography, coronary trees were severely caicified. Left main artery moderate stenosis with eccentric plaque. Mid LAD diffuse moderate stenosis , proximal Lcx moderate stenosis , and mid Lcx severe stenosis. Lcx was bended. and Please remember ,the burr was entrapped at this point. Which had dence calcification. * 高 炜北京大学第三医院 冠脉钙化病变的介入治疗 —— 旋磨的价值和并发症预防 冠脉钙化是临床常见的病变类型 冠脉钙化是心血管危险的预测因子，发生率高， 糖尿病、高脂血症、CKD患者冠脉钙化更高发，更严重 40～49 岁人群中的发生率为50% 60～69岁人群中的发生率为80％ 冠脉狭窄的百分比与钙化程度呈中度相关性 钙化的严重程度和范围与检出率有关 影像学评价手段与钙化病变的检出率有关-IVUS！ 钙化病变往往伴随血管成角、扭曲病变，以及对血管扩张剂的反应较差，所以，介入相关器械通过的难度，增加了PCI相关并发症，如支架脱落等风险的发生 钙化病变球囊成形术下球囊难以充分扩张，甚至发生球囊破裂等情况。高压扩张后，发生血管夹层、穿孔及血管破裂的机率也明显增加 钙化病变的挑战 钙化病变的风险和挑战 内膜撕裂并发症率高 单纯球囊扩张成功率低 血管顺应性差，支架置入困难 难以到位，支架脱落 支架膨胀不全或贴壁不良 高压扩张易造成严重内膜撕裂，导致急性血管闭塞 发生球囊破裂导致冠脉穿孔 在未充分扩张的钙化病变段置入支架即刻和远期风险均高-严重钙化是支架的陷阱 12atm 20atm 钙化→ 支架膨胀不全和内膜撕裂 球囊预扩张 支架植入困难 近端内膜撕裂 支架 内膜撕裂 支架膨胀不全 内膜撕裂 DES时代可能存在的问题 DES通过钙化病变时可能会造成涂层的破坏而削弱其预防再狭窄的作用 在未充分扩张的严重钙化病变植入DES时可能出现支架膨胀不全，贴壁不良，增加支架血栓 钙化病变可能影响局部的药物释放 TAXUS-IV亚组分析显示，钙化病变DES植入失败率较BMS高2倍 Death, MI, TLR (%) 0 3 6 9 12 15 Time in Months 0 1 2 3 4 5