冠状动脉造影基本方法及病变分析.ppt

狭窄的判断 血管直径 血管横截面积 2/3 = 67% 1/2 = 50% 1/3 = 33% 90% 75% 50% 直径法 面积法 * 定量冠脉造影分析 (QCA) * 冠脉狭窄程度的临床意义 冠脉狭窄直径大于50％以上，运动可诱发心肌缺血，所以认为是有意义的病变 直径狭窄小于50％，由于小冠脉阻力降低的代偿作用，即便运动也不会产生缺血，但可能会慢性进展或发生斑块破裂而形成急性冠脉事件 直径狭窄80％至85％以上者可引起静息时心肌缺血 * A型病变： 局限性病变（10mm） 向心型病变 非成角病变（45°） 较少或无钙化病变 非完全闭塞病变 非开口病变 主要分支血管未受累病变 非血栓病变 ACC/AHA冠脉病变分型 * B型病变： 长管状病变（10－20mm） 离心型病变 近段血管中度扭曲病变 中度成角病变（45°，90°） 中度至重度钙化病变 小于3个月的闭塞病变 开口病变 需要两根导引钢丝的分叉病变 血栓性病变 B型又分为B1和B2型（仅符合一项B型病变特征的为B1型，符合2项或两项以上B型病变特征的为B2型） ACC/AHA冠脉病变分型 * C型病变： 弥漫性病变（20mm） 近段血管过度扭曲病变 严重成角病变（90°） 大于3个月的闭塞病变和／或出现桥侧支血管 无法对主要分支血管进行保护的病变 退行性静脉桥血管病变 ACC/AHA冠脉病变分型 * Pitfalls of Coronary Angiography Eccentricity Foreshortening Overlapping Tortuosity * Modified from DiMario and Sutaria. Heart 2005;91:968–76 “Wall Irregularities” in LAD? * Modified from DiMario and Sutaria. Heart 2005;91:968–76 “Wall Irregularities” in LAD? * Modified from DiMario and Sutaria. Heart 2005;91:968–76 “Wall Irregularities” in LAD? * Left main stem Left circumflex (LCX) Left anterior descending (LAD) RCA Lesion Length * Foreshortening: Example Prox. LAD * Overlapping and Tortuosity ? A Clinical Case * no obstruction What about LM stem ? * Bubble!!! * * 谢 谢！ * * * Hockey Stick The Hockey Stick curves are often used for ostial or proximal lesions of superiorly oriented RCAs and CABGs. It has backup support between an FR and an Amplatz curve, and a straight primary curve that is good for delivering devices. The various lengths correspond to varying aortic root widths. A HS II would work best for a normal size root, a HS I for a small root and a HS III for a dilated root. El Gamal El Gamal has a straight primary curve with a longer tip and is occasionally used in accessing bypass grafts or difficult anatomy. El Gamal Relaxed has a more relaxed secondary curve than the El Gamal. These curves are designed to reshape to provide extra back-up support and engage difficult anatomical variations. Multipurpose Multipurpose curves are well suited for