课件：冠状动脉造影ABC.ppt

TIMI 心肌灌注分级 TIMI Myocardial Perfusion Grade: TMPG 0: Failure of dye to enter the microvasculature. TMPG 1: Dye slowly enters but fails to exit the microvasculature. TMPG 2: Delayed entry and exit of dye from the microvasculature. TMPG 3: Normal entry and exit of dye from the microvasculature. Gibson et al. Circulation 2000; 101:125-130 直接PCI后，虽然心外膜冠状动脉血流率高，但再灌注未成功 Brener SJ et al. Circ CV Interv. 2012;5:563-9 Farkouh ME et al. Circ CV Interv. 2013;6:216-23 心肌灌注分级 TIMI血流 ST段回落 镜下远端栓子和无复流 TIMI 3 级血流 无微血管灌注 Henriques JPS et al. EHJ 2002;23:1112-7 血栓分级 Grade 0: No cine-angiographic characteristics of thrombus present. Grade 1: Hazy, possible thrombus present. Angiography demonstrates characteristics such as reduced contrast density, haziness, irregular lesion contour, or a smooth convex meniscus at the site of total occlusion suggestive but not diagnostic of thrombus. Grade 2: Thrombus present – small size: Definite thrombus with greatest dimensions less than or equal to 1/2 vessel diameter. Grade 3: Thrombus present – moderate size: Definite thrombus but with greatest linear dimension greater than 1/2 but less than 2 vessel diameters. Grade 4: Thrombus present – large size: As in Grade 3 but with the largest dimension greater than or equal to 2 vessel diameters. Grade 5: Recent total occlusion, can involve some collateralization but usually does not involve extensive collateralization, tends to have a “beak” shape and a hazy edge or appearance of distinct thrombus. Grade 6: Chronic total occlusion, usually involving extensive collateralization, tends to have distinct, blunt cutoff/edge and will generally clot up to the nearest proximal side branch. Gibson CM et al. Circulation. 2001;103:2550-2554 Grade 5 thrombus Grade 4 thrombus 动脉瘤 A localized arterial widening (dilatation) that usually manifests itself as a bulge. Its presence may lead to weakening of the wall and eventual rupture. Grade 0: None – no ectasia present. Grade 1: Ectasia – visual