左主干病变pci中ivus的指导作用：是否必需？PPT.pptVIP

左主干病变PCI 中IVUS 的指导作用：是否必需？ ;术前评价LM病变;造影有局限性;;Of all the coronary segments, the LM has the greatest angiographic assessment variability - II;IVUS Predictors of the Events;Angiographic Predictors of the Events;Abizaid et al. JACC 1999;34:707;Sano et al. Am J Cardiol 2006;98:99M;MLA=12.5 mm2 MLD=4 mm;MLA =4.3 mm2 MLD= 2.3 mm;0;Treatment of LMCA Disease;对角支;IVUS-guided DES Implantation;“Optimal” MSA and TLR after DES Implantation (n=595);Independent predictors of mortality in 805 patients with LMCA disease treated with DES ;Impact of IVUS Guidance on All-Cause Mortality After LMCA DES Implantation (n=805);Using IVUS, most LM lesions show either insignificant disease or critical disease Absolute lumen CSA 6.0mm2 (or MLD 3.0mm) – independent of plaque burden - 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 The best available data indicates that IVUS-guidance during LM DES implantation will reduce 3-year mortality; the final MSA should be 8.5mm2 to minimize TLR. ;Is IVUS guidance necessary for the optimal diagnosis and treatment of left main lesions? Given all of this data, the known limitations of angiography, and the risks of making a mistake, how can you possibly argue otherwise?;THANK YOU !