ivus在lm介入治疗中的应用-课件，幻灯PPT.ppt

IVUS在LM介入治疗中的应用 首都医科大学附属北京友谊医院 王 雷 LM-PCI面临的特殊挑战: CAG提供的左主干病变程度、长度欠精确 LMd-LADo-LCXo的斑块分布决定分叉病变干预策略 位于“冠脉树”根部的LM生理特征变异大，纤维组织丰富，弹性强 LM的PCI过程必须迅速精确、支架置入完美 　　　　　　 血管内超声提供更多帮助 IVUS Guided LM-PCI IVUS更清楚显示LM病变部位和程度 IVUS决定LMd病变治疗策略 IVUS改善LMd病变治疗效果 Prevalence of LMSS IVUS : the most useful intracoronary diagnostic tool in the cath lab LM Bifurcation-IVUS Classification CAG 14.89% 4.27% 10.63% 29.78% IVUS 34.04% 6.38% 10.63% 25.53% CAG 8.51% 17.02% 14.89% IVUS 4.27% 12.76% 6.38% From Costantino Costantini et al. 47 Bifurcations IVUS-LM Plaque Distribution Oviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. [Epub ahead of print] IVUS-LM Plaque Distribution Oviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. [Epub ahead of print] IVUS determinants of LM FFR0.75 Jasti et al.Circulation 2004;110:2831-6 IVUS Criteria for a ‘Significant’ LMCA Stenosis Most IVUS LMCA studies show either insignificant disease or critical disease Absolute lumen CSA 6.0mm2 (or MLD 3.0mm) is the suggested criterion for a significant LMCA stenosis ? Correlates with a LMCA FFR0.75 ? Murray’s Law (LMCAr3 = LADr3 + LCXr3) ? Does not depend on finding a disease-free reference segment ? It is not clear whether the same criteria should be used for ostial LM lesions as for mid-shaft/distal bifurcation lesions and for positively vs negatively remodeled lesions ------From Gary S Mintz-TCT2009 Conclusions: IVUS guided stenting reduced long-term mortality rate compared with conventional angiography-guided stenting in DES placement for unprotected LMCA stenosis The differential survival rate between IVUS-versus angiogrphy guidance start to separate and progressively diverged after 1 year Therefore,the reductioin of the risk of very late stent thrombosis by IVUS- guida