PPCI术中血栓的管理.pptxVIP

直接经皮冠状动脉介入治疗（PPCI）术中血栓的管理The Management of Thrombus in Primary Percutaneous Coronary intervention;Acute coronary syndromes; ; ; ;血栓负荷的重要性;MBG and death or death/reinfarction;冠脉内血栓增加了PPCI风险;优化组织水平再灌注是重要的治疗目标;血栓的形成与管理;冠状动脉内血栓治疗的进展;;血栓抽吸在STEMI急性期介入治疗中的价值; Adjunctive devices have been developed in an attempt to improve clinical outcomes by removing thrombi and to protect against distal embolization during PCI Classes of devices include: Catheter aspiration thrombectomy devices Mechanical thrombectomy devices Embolic protection devices ;Explanation of Thrombectomy Devices;Explanation of Thrombectomy Devices; Occlusion balloon is advanced over a guidewire proximal to the thrombus Angioplasty or stenting procedures take place Thrombotic debris is trapped by the balloon and aspirated; Occlusion balloon is advanced over a guidewire distal to the thrombus Angioplasty or stenting procedures take plac Thrombotic debris is trapped by the balloon and aspirated ;Filter is advanced over a guidewire distal to the thrombus Angioplasty or stenting procedures take place Thrombotic debris is aspirated or trapped by the filter and removed;;STEMI患者血栓抽吸的临床证据;手工血栓抽吸的临床证据; TAPAS 研究 最大的前瞻性随机对照单中心研究，具有里程碑意义;结论：与常规PCI组比较，抽吸组心肌再灌注指标明显改善，1年全因死亡减少38％（P=0.04）、心源性死亡下降46％（P=0.02）、再梗死事件降低 49％（P=0.05）、心源性死亡或非致命性再梗死事件减少 43％（P=0.009），心肌再灌注指标（心肌呈色分级、ST段回落程度）改善与预后（心源性死亡、全因死亡、心源性死亡或再梗死）改善相关（P≤0.004～0.0001） ;;结果：24 个月的主要心脏不良事件分别为13.7%和4.5%（P = 0.038）和心脏猝死是6.8%和0%（P=0.012）。心脏猝死的发生率和组织灌注参数之间存在着相关性（术后心肌灌注分级和ST段）。; 与常规直接PCI相比，采用普通抽吸导管策略可以使 TIMI 3级血流和MBG 3级比率提高7.3％和64％（P＜0.0001）、远端栓塞率降低60％（P＜0.0001）、术后1个月死亡减少45％（P=0.04）;ATTEMPT 荟萃分析;结论：STEMI患者可从手动血栓抽吸策略中获益;Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients With ST-Segment Elevation Acute Myocardial InfarctionReport of the VAMPIRE (VAcuuM asPIration thrombus REmoval) Trial;Anne Kaltoft et al.Circulation,2006,114(1):40-47;Intracoronary Abciximab and Aspiration Thrombectomy