21-左主干病的介入治疗.ppt

箴言 地上本没有路，走的人多了，也便有了路； 股市有风险，投资需谨慎。 * 谢 谢！ * * SYNTAX对PCI预测价值好，而对CABG无预测作用 * * SYNTAX评分中危及低危之间级差较小，GRC三层差异更显著 * * 越靠近右下角说明预测价值越好 * * * * * SYNTAX 3-Year Report_Randomized_12JUL10.doc exhibit 51 Insights Into the Crush Technique * Crush Technique The technique can be performed easily . It assures both branches patency and provides excellent coverage of the SB ostium .but ….. * The Crush Technique Insight From Bench * Reach the Carena Fit the anatomy A sligtly modified stent with a a different stent implantation technique? * Culotte stenting Double stent technique-2 T stenting * Complete coverage of the SB ostium is still a challenge for “T” stenting Variants of T-Stenting * Culotte Technique This technique is suitable for all angles of bifurcations and provides near-perfect coverage of the SB ostium. * Intravascular Ultrasound Classification of Plaque Distribution in Left Main Coronary Artery Bifurcations Oviedo C, et al. Circ Cardiovasc Interv. 2010 Conclusion: Angiographic classification of LMCA bifurcation lesions is rarely accurate * 动脉粥样硬化斑块好发于分叉处，嵴较少累及 * Treatment of SB compromiseplaque shift vs. carina shift Gentle kissing to relocate the carina * Bifurcation angle and long-term outcome A high bifurcation angle (50°) is an independent predictor of long term MACE after bifurcation crush stenting Dzavik Am Heart J 2006;152:762-9 Bifurcation angle is an independent predictor of binary restenosis (HR 1.53 [1.04–2.23] per 10 degree increase) after Culotte stenting Adriaenssens Eur Heart J 2008;29:2868–2876 With steep SB angles (70°) and Crush, conventional kissing post-dilatation does not fully expand the stent at the SB ostium. Need for 2 step kissing. Ormiston Catheter Cardiovasc Interv 2004;63:332-336 A narrow LMCA-LCX angle was associated with less expansion of the LCX stent at the ostium (during crush stenting) and a higher likelihood of incomplete stent apposition. Murasato Catheter Cardiovasc Interv 2007;69:248-256 * LMCA bifurcation a