PCI术中夹层、血肿、栓塞和无复流的识别及处理 [正式3].ppt

2、无复流原因 阻力血管(小动脉和直径200 μm的前小动脉)功能受损所致 可能机制： 微栓塞 心肌细胞及血管内皮细胞肿胀 炎症反应 毛细血管中性粒细胞栓塞 血小板激活和聚集形成微血栓 毛细血管肌细胞挛缩 3、无复流危险因素 临床因素： ACS、糖尿病、高血压等 血管病变因素: 闭塞病变、血栓病变和弥 漫病变等 冠脉介入方式: 旋磨和旋切 　 4、无复流的治疗 硝普钠 法舒地尔 硝酸甘油 腺苷 尼可地尔 乌拉地尔 维拉帕米 地尔硫卓 GP Ⅱb/ Ⅲ a受体拮抗剂 远端保护装置 1958 The first coronary angiogram was performed by Dr. F. Mason Sones, Jr., a pediatric cardiologist at the Cleveland Clinic. * ③假腔内造影剂排空延迟； ④真腔可有局限性狭窄或增宽，夹层远端可狭窄。只要认真观察，可有效治疗防止严重并发症。必要时血管内超声IVUS可以提高检出率。 * ③假腔内造影剂排空延迟； ④真腔可有局限性狭窄或增宽，夹层远端可狭窄。只要认真观察，可有效治疗防止严重并发症。必要时血管内超声IVUS可以提高检出率。 * Figure 1 [superior panel, A–D (from distal to proximal vessel), where asterisks represent wire artefact]. OCT accurately visualized (i) the affected coronary wall along the entire vessel length, (ii) the thickness and circumferential distribution of the intimo-medial dissection flap, (iii) the variable extent of lumen compromise (slit-light lumen in some segments) and the false lumen (FL), (iv) the emergence of all involved side-branches (SB) from the true lumen, and (v) the precise location of a proximal, confined, intimal tear (entry door) (arrows). After stent implantation [Figure 1, lower panel, E–H (from distal to proximal vessel), where asterisks represent wire artefact], OCT revealed a well-expanded stent (ST), fully apposed against an apparently normal vessel wall and a small, residual, non-communicating dissection (intramural haematoma) with an improved coronary lumen at the distal vessel. * 4.如发生螺旋形撕裂，首先于撕裂的远端点状植入支架，防止撕裂继续向远端扩展，然后于撕裂近端点状植入支架，以使夹层完全封闭。 ? ?? 5.大血管近端夹层导致大面积心肌梗死或缺血，特别是合并低血压、休克而球囊扩张或支架植入不成功时，应立即进行急诊 CABG 。 * ?Intravascular ultrasound showing dissection and intramural haematoma starting from the left coronary ostium and progressing into the left anterior descending and the cin compression of the real lumeircumflex arteries. Intramural haematoma in the media of the arterial wall resulted n. An intimal tear was not observed. * Thrombus material (in a cup, upper left corner) removed