在lm介入治疗中的应用课件幻灯.pptVIP

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-LADo-LMd Lesion distribution IVUS-LM Lesion LocalizationPatients (n=75) LM Bifurcation-IVUS Classification IVUS-LM Plaque Distribution IVUS-LM Plaque Distribution IVUS determinants of LM FFR0.75 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 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) ≤2.8mm LM成功支架置入的IVUS标准: 完全贴壁: 沿支架置入段支架完全帖靠血管壁 对称均匀: 支架最大直径比最小直径≥0.7 扩张充分: 支架最小腔面积(CSA)比平均参考血管 腔面积≥0.9 LM-Case Presentation in Recent Work CASE 01 Case 01 Case01 Case 01 Case 01-Final Result Case02 Case02 Case02 Case02 Case 02 Case02-Final Result Conlcusions Pre intervention IVUS is mandatory if technically possible 1.Important qualitative and quantitative information permit best approach. 2.Determine whether or not and how to do. Post intervention IVUS is mandatory as possible as you can It decreases mortality! THANKS FOR YOUR ATTENDING 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 IVUS : the most useful intracoronary diagnostic tool in the cath lab 贾三庆