21-左主干病变的介入治疗综述.ppt

左主干病变的介入治疗 ;冠心病分册编写人员名单;LM病变的概念;LM病变分类;分类－－按部位;分类－－按侧枝;有保护左主干病变;无保护左主干病变;无保护左主干（ULMCA）病变的特点 ;ULMCA不同治疗方法的临床疗效评价 ;冠状动脉旁路移植术（CABG）;单纯球囊成形术 （PTCA）;First PCI of Left Main in the World;冠脉内支架术 ;左主干病变PCI：ACC/AHA/ESC指南;实践－DES in LM Registries;左主干：BMS vs CABG;左主干：DES vs CABG;Clinical Outcomes up to 4 yearsLM Subset;LM PCI所面临的问题;Syntax: good predictive ability inthe PCI scenario, while poor in CABG scenario;Improved AUC of CSS compared with Syntax score or ACEF score;EuroScore System;The Global Risk Classification (GRC);Comparison of different risk models--- GRC score had the highest predictive value;Comparing different risk score for LM revascularization: Syntax, EuroScore, CSS, GRC ;左主干病变介入治疗的适应症和禁忌症 ;有保护左主干病变 ;无保护左主干病变适应症;无保护左主干病变相对禁忌症;左主干病变理想的暴露体位 ;左主干开口 ;左主干开口;LM体部/干段;LM体部/干段;LM末端;LM末端;器械选择及手术技巧 ;手术路径---与选择的器械大小及病变特点有关 ;导引导管 ---不影响冠脉灌注、避免损伤血管为原则;导引导丝---良好地支持;球囊---充分预扩张 ;支架---良好的支撑;不同病变的处理原则 ;LM-PCI－－左主干开口病变;LM-PCI－－左主干开口病变;Angiography: how to engage the catheter into the LM-stent which protrude into aorta?;LM Ostium Stent Position;How to Ensure Stent Positioning Accurately ?;Stent position in LM ostium;LM OSTIUM;How to evaluate stent apposition without IVUS?;LM-PCI－－左主干干段病变 ;LM-PCI－－左主干远端分叉病变 ;How to select the stent diameter?;Bifurcation natural branching laws;What about LM diameter?;Dilation Limit after Postdilation;Double stent technique-1;Kiss Stenting;Kiss stenting : asymmetrical metal overlap and double lumen ;Insights Into the Crush Technique;Crush Technique;The Crush Technique Insight From Bench;Reach the Carena Fit the anatomy;Culotte stenting ;Complete coverage of the SB ostium is still a challenge for “T” stenting;Culotte Technique;Intravascular Ultrasound Classification of Plaque Distribution in Left Main Coronary Artery Bifurcations;动脉粥样硬化斑块好发于分叉处，嵴较少累及;Treatment of SB compromiseplaque shift vs. carina shift;Bifurcation angle and long-term outcome;LMCA bifurcation angle;SYNTAX : MACCE to 3 Years≥ 2 stents in LM Bi/Trifurcation;LMCA bifurca