冠状动脉分叉病变介入治疗新进展.PDF

冠状动脉分叉病变介入治疗新进展 南京医科大学附属南京医院 南京市第一医院 南京市心血管病医院 田乃亮 陈绍良 Bifurcation Lesions are Still a Challenge 冠状动脉分叉病变占PCI的15-20%， 目前仍然是介入治疗的一个难题， 其成功率较低，术中因分支急性 闭塞风险高，术后再狭窄率高， 因而主要心脏不良事件（MACE） 和靶病变血运重建（TLR ）率， PCI术后支架内血栓发生率也高 Anatomical Features of Bif. Lesions location/length: LMd, non-LMd SB sizes: cut-off diameter=2.5 mm Bif. Angle: inconsistent solutions Myocardium at jeopardy of risk: SB size? Predictors of SB closure after stenting MV Co-morbidities: DM, EF ↓,renal dysfunction Procedural failure: tortuous, angulated, calcified, diffuse Which one is the most important factor? Medina Classification MB Distal MB SB Proximal 0, 1, 1 1, 1, 1 1 , 1, 0 1, 0 , 1 0, 0, 1 1, 0, 0 0, 1, 0 Medina A. et al. Rev Esp Cardiol. 2006; 59: 183-4 Information from current classifications Better one because 1. easily to be numerized 2. easily to remember 3. simple classification Best?NO lack of lesions features lesion length RVD angle calcification/tortuousi 分叉病变介入治疗的核心问题  单支架还是双支架？  如果选双支架术，应该采取何种策略?  策略选择的根据