成都心血管会议交流医学课件.ppt

小结 中重度钙化病变是PCI术中发生急性血管闭塞和手术失败及术后再狭窄和血栓形成的重要原因 钙化病变的处理是多角度全方位的处理 以旋磨为代表的去斑块技术是处理钙化病变的重要技术 Median scores for age categories in men and women separately. * ROTA again B.Braun 2.5×15mm 12atm EXCEL 2.75×24mm 14atm EXCEL 3.0×24mm 16atm Final Result 冠脉CTA示：左主干远端、前降支原支架内及支架外远端有钙化病变。 Case 1 左冠造影示：左主干远端、前降支原支架内及支架外远端有钙化病变。 Case 3 1.75mm旋磨头，分别在左主干远端、前降支原支架内及支架外远端处旋磨。 Case 3 原支架外远端钙化处旋磨后钙化斑块断开，残余管腔面积由原来的2.9增大到3.9 原支架远端钙化处旋磨后IVUS图像 原支架远端钙化处旋磨前IVUS图像 原支架内钙化处旋磨后钙化如右比较：钙化分散，显现支架，残余管腔面积由2.44增为2.65 原支架内钙化处旋磨后IVUS图像 原支架内钙化处旋磨前IVUS图像 左主干钙化处旋磨后残余管腔面积由7.09增为8.05 左主干钙化处旋磨后IVUS图像 左主干钙化处旋磨前IVUS图像 Case 2 Rota for severe calcificated lesion 82 Year Old Chinese Male Chief Complaint： Recurrent chest pain 11 years Worsening for 3 months Medical History RCA 2 stents 8 years ago Hypertension Diabetes Subtotal gastrectomy Rotablator burr1.75mm and IVUS The comparison of before and after Rotional at LM Pre-Rota Post-Rota SeQuent 2.5*15mm pre-dilate Xience V 3.5*28mm Voyager 3.5*12mm Final result Post-stent IVUS Discussion During DES era, RA is more useful technique for the patients with complex lesions, especially calcified and non-dilatable lesions. The purpose of RA is to making a high quality of deployment of stent in stead of big debulking as possible. Our experience to decrease complications depending on : Increasing burr size step by step Reasonable Burr/artery ratio (0.5-0.7) Maintaining SBP≥100mmHg Enough time for observing coronary flow between two rotations The meaning of IVUS Viewing site and range of calcification Selection of burr size Evaluate the effect and complications of rota Quality of stent deployment Type of lesion(n=289) No of Pts Age(yrs) A B1 B2 C 253 73±12 23 25 154 87 Our Data from Aug 2006 to Aug 2011 Patients characteristics Procedure Success Burr/artery Ratio (1.25-2.0mm) Adjunctive Balloon Stenting After Rota 283(98%) 0.55±0.08 (1.25-2.0) 246(85%) 100% PCI procedure descri