病变的技巧冠心病最新进展ppt课件.ppt

CTO病变的支架选择 CTO病变中PTCA和支架植入术比较：再狭窄发生率 CTO病变中PTCA和支架植入术比较：再闭塞发生率 相对于单纯PTCA术，金属裸支架降低了再狭窄和再闭塞率，但仍然比较高． 与金属裸支架相比雷帕霉素药物支架明显降低了低或中危再狭窄风险病人的晚期管腔丢失和再狭窄率 CTO中应用CYPHER stent 的经验 Hoye A., et al., J Am Coll Cardiol 2004;43(11):1954-8. -56例CYPHER治疗 Ge L., et al.,Eur Heart J 2005:26(11):1056-62 -122例CYPHER治疗 Nakamura S., et al., Am J Cardiol 2005;95:161-6 - 60例CYPHER治疗 The SICTO Study CYPHERTM Sirolimus-eluting stent in Chronic Total Occlusion The PRISON II Study Primary Stenting of Occluded Native Coronary Arteries  SICTO STUDY DESIGN A multicenter, prospective, non-randomized study to assess the feasibility and restenosis/reocclusion rates of coronary stenting with the CypherTM Sirolimus-eluting stent in patients with chronic total occlusion 25 patients were treated with the CypherTM Sirolimus-eluting stent after successful balloon angioplasty and IVUS examination. Clinical follow-up at 30 days, 6, 12, 18 and 24 months - repeat angiography and IVUS at 6 months follow-up. SICTO – Conclusion In this feasibility study the CYPHERTM Sirolimus-eluting stent was very effective in the treatment of CTO, with very low rates of TLR (0%), MACE (0%) and TVR (8%) compared to historical data with bare stents (30-50%). The CYPHERTM Sirolimus-eluting stent significantly inhibits intimal hyperplasia in CTO. These preliminary data will come in addition of larger database with CTO subpopulation (e.g. e-Cypher) PRISON II Study To compare the immediate and long-term angiographic and clinical results of BMS (Bx Velocity?) implantation with Sirolimus-eluting Stent (CYPHER?) implantation for the treatment of CTO 6-month Clinical Follow-up Clinical Event (%) 20 4 P0.001 24 8 22 8 19 4 3 2 0 P=0.003 P=0.009 P=0.001 P=NS P=NS 0 6-month Angiographic Follow-up In-Stent BMS (n=94) SES (n=94) p value Ref. diameter (mm) 3.01 ± 0.85 3.44 ± 0.54 0.0001 MLD (mm) 1.47 ± 0.83 2.48 ± 0.80 0.0001 % diam. stenosis 48.75 ± 26.52 22.01 ± 20.98 0.0001 Late Loss (mm) 1.09 ± 0.91 0.05 ± 0.81 0