ffr临床应用文件材料教学稿件.ppt

What can be learned and achieved from “FFR-guided PCI”?; FFR=;是否行介入治疗？; FFR真正的意义在于告诉我们这个病变是否需要PCI。 FFR已经成为冠脉狭窄功能性评价的金标准。 ;FFR 压力导丝的临床应用;Where can we use pressure wire?;临界病变;VA 10.2mm2 LA 7.4mm2 Plaque Burden 27.0% ;VA 10.49mm2 LA 2.54mm2 Plaque Burden 75.7% ;Nam CW, et al. JACC interv 2010:3:812;Where can we use pressure wire?; ; ; ; ; ; ; ; ; ;FFR 0.87;在造影认为的3支病变中，经FFR测量 14% 是 3-VD ????????? 43% 是 2-VD ????????? 34% 是 1-VD ???????? 9% 是 0-VD ?;多支病变FFR的应用 ;Where can we use pressure wire?;0.70; 在最大充血状态下进行PULL-BACK 1、把导丝放置于病变冠脉的远端。 2、静脉连续滴注ATP或腺苷，诱导最大充血状态。 3、如果FFR0.8，则串联病变可诱发缺血，PCI是合适的。 4、在透视状态缓慢回撤导丝，发现有突然压力改变的点或节段。如果局部压力阶差≥10mmHg，可以考虑在这个部位放置支架。 5、优先处理压力阶差大的病变，如果病变压力相似，优先处理远端病变。 ; 在最大充血状态下进行PULL-BACK 6、最严重的病变放置支架后，需要再次做PULLBACK， 需要理解的一点，在最严重的病变放完支架，与术前比， 其他病变的压力阶差会上升。 重要规律：一个严重的远端病变可以掩盖近端病变的压力阶差，反之亦然。 ;1;Where can we use pressure wire?;弥漫长病变;How to Distinguish Focal from Diffuse ?;Hennico Walter 85621;Sensor Left in Distal LAD;Hennico Walter 85621;Hennico Walter 85621;压力的测量和弥漫病变 ;弥漫病变压力测量 ;Pressure Measurements in Diffuse Disease ;Multiple stenoses and diffuse disease: In some patients, focal or segmental pressure drops can be detected and stenting in the right way is beneficial, like in the patient above. Sometimes, however, there are no focal or segmental pressure drops, but decline of pressure is homogeneously distributed all along the artery,In such cases, PCI is not possible and has no sense and stenting is only a cosmetic Treatment.;Where can we use pressure wire?;左主干开口狭窄;;开口和左主干病变 ;左主干狭窄 ;213 patients with angiographically equivocal LM CAD;左主干狭???的评估;Where can we use pressure wire?;Various size, various amount of supplying myocardium Side branch ostial lesion is unique Underlying plaque ? Eccentric plaque Remodeling ? Negative remodeling Mechanisms of luminal narrowing Carina shift, plaque shift, stent struts, thrombus…..;Fractional Flow Reserve;FFR=0.67;介入前 主要分支PCI术后 边