ivus在lm介入治疗中的应用-课件幻灯演示幻灯片.pptVIP

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 IVUS-LADo-LMd Lesion distribution 贾三庆，张宇晨，王雷，等.中华实用内科杂志，2002，4（14）7-9. IVUS-LM Lesion LocalizationPatients (n=75) Only Ostial 21% Only Mid Shaft 13.1% Only Bifurcation 65.5% From Costantino Costantini et al. 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- guidance might play a role in improving survival after DES placement Effect of IVUS upon Mortality of LM Stentingn=201 pairs (BMS+DES) Effect of IVUS upon Death or MI of LM Stenting n=201 pairs (BMS+DES) Effect of IVUS upon TVR of LM Stenting n=201 pairs (BMS+DES) Effect of IVUS upon Mortality of LM Stentingn=145 pairs(DES) 对LM进行血运重建的IVUS标准: 最小管腔面积≥6mm2 管腔面积狭窄率＞50% 最小腔径(MLD) ≤2.8