《开口及分叉处病变》课件.ppt

谢谢！ 开口及分叉处病变 开口处病变 Ostial Lesion Classification Aorto - ostial Branch Ostial Junction between the aorta and orifice of the RCA, SVG, or LM Junction between a large epicardial vessel and its branch; also called “origin” lesion Aorto-Ostial Lesions: Guiding Catheter Selection The key to success is co-axial alignment, not a “power position.” Remember that sidehole guides will permit passive perfusion and reduce pressure damping and ischemia, but do NOT prevent vessel injury. Aorto-Ostial Lesions: Guiding Catheter Technique Active manipulation of guiding catheter is essential! Aorto-Ostial PTCA: Watermelon-Seeding SOLUTION: Long balloons (30-40 mm) Cutting balloon Rotablator (calcified lesions) Approach to Aorto-Ostial Lesions (No calcification) Vessel 2.5 mm Vessel ? 2.5 mm Rotablator Cutting balloon PTCA Rotablator Cutting balloon PTCA or DCA DES DES Approach to Aorto-Ostial Lesions (Significant calcification) Consider IVUS for sizing, assessment of extent of Ca++ Rotablator * * Cutting balloon is not a suitable substitute for most calcified stenoses. DES Aorto-Ostial Lesions: DCA Proper technique requires gentle retraction of the guiding catheter 2-3 cm into the aorta prior to cutter activation. It is important to establish other landmarks (rib margins, catheter shaft) to ensure precise positioning of the AtheroCath. Failure to retract the guide may result in partial excision of the tip of the guide during cutter activation. Aorto-Ostial Lesions: Rotablator Proper technique involves selection of a guiding catheter that provides ideal coaxial alignment and use of a Rotablator support guidewire. After crossing the lesion with the guidewire, allow the guide to gently “kick-out” of the ostium to facilitate ablation of the ostial lesion. The platform speed should be adjusted in the guiding catheter. Remove all slack in the guidewire to avoid kinking at the ostium. Aorto-Ostial Lesions: Stent Position the stent-delivery balloon so 1 mm of stent extend