复杂冠脉分叉病变的PCI治疗策略.ppt

PCI Strategies for Complex Coronary Bifurcation lesions Nordic Bifurcation Study (n=413) Nordic Bifurcation Study (n=413) One Stent Strategy Provisional T Stenting Provision-T stent technique 53 pts, SB2mm MACE 9.4% at 14+/-3 months TLR 3.8%, MV restensosis 3.2%, SB 12.9% at 6 months Two Stents Techniques T stent Culotte SKS V stent Provisional T Modified T stent Y stent Clinical Outcomes In BMS era, the incidence of TLR was 24% at 6 months (Chevalier. Am J Cardiol 1998;82:943) In DES era, the incidence of MACE was 5.3% and TLR was 15.4% (Hoye, et al. Int J Cardiovasc interven 2005;7:36) Culotte vs T stent in DES era Clinical Outcome Clinical Outcome Clinical Outcomes The survival rate free of TLR was 90.3%, incidence of restenosis at MB was 9.1%, restenosis at SB was 25.3% (Hoye A . J Am Coll Cardiol 2006;47:1949-1958 ) Incidence of TLR at 6 month follow-up is 11.3% (Moussa I Am J Cardiol 2006；97：1317－1321) Balloon Crush DK Crush ( Sleeve Technique) mini-crush 45 pts, 52lesions Procedural success 100% No in-hospital MACE TLR 12.2%, MV restensosis 12.2%, SB 2% at 8 months In vitro TAP stenting Tips and tricks 球囊外径：2.9F+2.6F=5.5F 6F导管内径：0.070 inch﹤5.4F Case of TAP stenting Coronary Angiography Final kissing balloon Clinical study of TAP Angiographic characteristics Clinical outcome (9 month) Select the size of GC Wire side branch and dilate Kissing balloon SB stent positioning SB stent is deployed with the uninflated balloon into the MV The balloon of the SB stent is slightly retrieved and aligned to the MV balloon Final kissing balloon Perfect coverage of the bifurcation with minimal stent’s struts overlap at the proximal part of SB ostium 0.070” 0.071’’ 0.078” 6F 7F ≤5.3F 5.4F ～5.9F Size of Guiding Catheter MV balloon shaft profile + SB stent shaft profile 8F ≥6.0F 0.088” 6 F 7 F 8 F GC 2.9F Powersail 2.55F Avita 2.6F Sprinter 推送杆外径 球囊种类（≤3.5mm) 2.8F 3.0 2.7 2.6 2.5 AVION Extensor Voyager Grip CTO 2.7F Aqua T3 2.6F