严重钙化病变的pci治疗王海昌.ppt

Application of Percutaneous Coronary Intervention for Severe Calcification Lesions Culprit and Healed Plaques in a Coronary Bifurcation Epidemiology 由动脉粥样硬化导致，非退行性变 检出率存在显著的性别差异 （女：男=1：2） 冠状动脉钙化计分随年龄增加呈增加趋势 冠心病危险因素与冠状动脉钙化密切相关 Bakdash 等报告非脂质性冠状动脉危险因素的数目与冠状动脉钙化沉积有关 29% of men and 15% of women who had no cardiovascular symptoms and exhibited no other common risk factors, had extensive coronary artery calcification. [European Heart Journal 25: 48–55, 2004] Calcified coronary plaques imaged in vivo by optical coherence tomography (OCT) and intravascular ultrasound (IVUS) Case 1 ( Balloon + DES) Initial Reaction :Fear Atherectomy  Laser Rotablator : rotational atherectomy catheter Rotablator Syetem Case2：Severe Calcification and Balloon Suboptimal Dilation lead to Acute Stent Thrombosis Case2：Severe Calcification and Baloon Suboptimal Dilation lead to Acute Stent Thrombosis 132 patients – at least one moderate-severely calcified lesion on fluoroscopy Rotablation/DES vs DES alone Primary endpoint – 8 month binary angiographic restenosis Secondary endpoints – procedural success/MACE; acute/subacute/late stent thrombosis Observations to date re impact of Rotablation on procedural outcome in calcified lesions In arriving at 56 pts in DES alone limb, of 64 pts intended for this limb, 8 (12.5%) unable to predilate fully (placed in ROCCSTAR Rotablator registry) Subacute stent thrombosis 2/56 (3.6%) in DES alone limb (both in small vessels) vs 0/57 in Roto/DES limb Rotational atherectomy expands the potential for safe and effective percutaneous treatment The device is indicated particularly in high risk pts turned down for CABG( calcification). There may also be longer term benefits in reducing restenosis – improved stent deployment, reduced adventitial plaque, reduced plaque shift. THANK YOU Male ，57yrs Smoking 30yrs， Chest pain 3yrs， Rest ECG：V1-V3 lead ST segment depression0.1mv Cadiac Triponin T(-) Severe Calcification Baloon dilation Stenting 4