分叉病变的预处理和优化治疗策略_1015 - Copy.pptVIP

Her Yonsei Med J 2016 May;57(3):606-613 DCB治疗de novo分叉病变 仅在主支使用DCB治疗 从手术结束至随访9个月时 侧支口管腔面积有所增加 管腔面积从1.03增至1.42mm2 Her Yonsei Med J 2016 May;57(3):606-613 DCB治疗分叉病变值得探讨的问题 Int J Cardiol. 2016; 220: 589-594. Clin Res Cardiol. 2016 Jul 5.[Epub ahead of print] Int J Cardiol. 2016; 215: 80-83. FFR引导的DCB血运重建策略 ——一项前瞻性临床研究证实FFR引导下的DCB血管 成形术是安全有效的 分叉病变治疗的完全“降解模式”：DCB+BVS ——主支植入BVS + 分支DCB治疗 已有多种DCB上市，但无不同DCB直接比较的数据 DCB的使用流程 病变准备 采用切割球囊进行充分预扩张 球囊/血管直径比率 0.8-1.0, 扩张压力标准压 单纯DCB治疗（DCB only） DCB远端和近端至少比预扩张区域长2-3mm 球囊/血管直径比率 0.8-1.0 7-8 atm，扩张30-60秒 支架术 植入DES DAPT 仅DEB：1-3个月 BMS-ISR：1-3个月 DES-ISR：时间取决于DES，但至少1-3个月 Spot-BMSDEB：3个月 DAPT 根据当前指南进行 血管造影结果可接受 无夹层或仅为A或B级 TIMI血流III级，残余狭窄?30 夹层C-F级 或TIMI血流III级 或残余狭窄30% 中国介入心脏病学杂志. 2016; 24(2): 24-30 药物涂层球囊学习曲线 - 逐步原则 小 结 分叉病变治疗中，棘突/切割球囊可以进行充分预扩张，减少斑块移位导致分支闭塞 以DCB额外进行分支血管扩张可改善血管造影结果，是分叉病变单支 架术治疗的优化方案；切割球囊的预处理可以确保DCB的输送性和药物释放的充分性 随着无植入物理念的发展，主支和侧支血管DCB血管成形术在临床的 应用越来越广泛：血管造影结果优于POBA，MACE和TLR发生率低 * * * * In the left image, the stent (red) fits the carina perfectly without protruding into the main branch. The disadvantage of this approach is that any disease existing in the proximal part of the lateral branch (blue triangle A) will not be covered by the stent. In contrast, in the central image, the stent fits the origin of the lateral branch and perfectly covers the entire proximal disease of this branch (red triangle A). The disadvantage of this strategy is that the medial part of this stent protrudes over the main vessel (red triangle B). In routine clinical practice (right image), the most proximal part of the stent (*) can even be above the origin of the lateral branch. In these latter 2 situations, it is necessary to crush the entire medial and proximal part of the stent implanted in the lateral branch with another stent in the main vessel (not shown). Thus, the lateral branch ends up double-caged and, also, the area immediately proximal to the exit of the lateral branch has three metal la