严重钙化病变的pci治疗王海昌PPT.ppt

Case2：Severe Calcification and Balloon Suboptimal Dilation lead to Acute Stent Thrombosis Male ，57yrs Smoking 30yrs， Chest pain 3yrs， Rest ECG：V1-V3 lead ST segment depression0.1mv Cadiac Triponin T(-) Severe Calcification Baloon dilation Stenting Case2：Severe Calcification and Baloon Suboptimal Dilation lead to Acute Stent Thrombosis 4 days later!!! Female，76yrs Exertional chest pain 8yrs, recurrent 10days EF:40% RCA1:50％，RCA3:75％ LAD6：75％,7段90 with severe calcification， 8:50％，9:50％； LCX13:100％,14:25%,15: 50％ Case3： Rotational Atherectomy for Severe Calcification Cutting Balloon: 2.5*10 (16ATM, 20) Post dilate balloon: 2.5＊13 (18ATM, 12) Case3： Rotational Atherectomy for Severe Calcification Guiding ： 6F EBU3.5Guide Wire： Stablizer/ PT2MS Bur: 1.5mm Rotor rate ： 160000 rpm Case3： Rotational Atherectomy for Severe Calcification 2.5＊24 TAXUS(10ATM, 8) 2.75＊28 TAXUS(12ATM, 7) Final CAG Stenting 钙化病变的器械选择（I） 导引导管： 强支撑力 导引导丝：亲水涂层导丝， 支撑力 好， 采用微导管交换钢丝 球囊和支架通过性好 钙化病变的器械选择（II） 支架 建议选择设计有桥连接的支架 设计良好的管状支架，闭环系统、辐射力好、金属覆 盖率好。能够使支架更合理扩张、血栓率低、再狭窄 率低 旋磨头 依据血管直径，从小到大更换，最大旋磨头应 选择直径小于血管直径的75％。 * * * Xijing Hospital * * * Xijing Hospital Application of Percutaneous Coronary Intervention for Severe Calcification Lesions 严重钙化病变的PCI治疗 王海昌 第四军医大学西京医院心脏内科 陕西西安 Culprit and Healed Plaques in a Coronary Bifurcation Coronary artery disease : Diffuse disease with a variable mix of stable , vunerable and culprit plaques Fuster V, etal. JACC, 2005:46:937-954 Epidemiology 由动脉粥样硬化导致，非退行性变 检出率存在显著的性别差异 （女：男=1：2） 冠状动脉钙化计分随年龄增加呈增加趋势 冠心病危险因素与冠状动脉钙化密切相关 Bakdash 等报告非脂质性冠状动脉危险因素的数目与冠状动脉钙化沉积有关 29% of men and 15% of women who had no cardiovascular symptoms and exhibited no other common risk factors, had extensive coronary artery calcification. [European Heart Journal 25: 48–55, 2004] Calcified coronary plaques imaged in vivo by optical coherence tomography (OCT) and intravascular ultrasound (IVU