冠脉分叉病变介入技巧培训课件.pptVIP

The step crush technique Case: The step crush technique First kissing Second kissing Final result The step crush technique 优点: 6F guiding catheter可以完成操作，特别适合于桡动脉经路，第二次导丝和球囊再次通过较容易成功。 缺点: 同 the standard crush technique. The inverted crush technique The inverted crush technique 适用于分支管径不小于主支的情况。 分支支架挤压crush主支支架。 缺点: 同 the standard crush technique. 分叉病变介入技巧 Classification of bifurcation lesions according to plaque burden A:Duke B:Sanborn C:Safian D:Lefevre 一个好还是两个好？ 如果选２个，应该采取何种策略 ? 策略选择的根据 简单化 vs 复杂化 循证结果 vs 个人选择 并发症率 (especially MI / thrombosis) 分叉病变介入治疗- 关注热点 Stenting for bifurcation lesions in 2007 主支放支架，分支临时决定 Stenting the main vessel with provisional stenting of the side branch Provisional Stenting Strategy If 2nd stent is needed for side branch following main vessel stenting Modified T-stenting Reverse crushing Culotte stenting 分支血管的保护与放置支架 并非所有分支血管同等重要! 根据以下情况实施分支血管保护和支架植入 分支血管大小与分布区域 分支血管开口病变与病变程度 分支与主支成角程度 Side branch closure after PCI Side-branch may be compromised following main vessel stenting Pre-treatment After stenting Plaque shifting (“Snow-plow”) Ostial spasm or Side-branch compromise by stent material Dissection of plaque at origin of side-branch Dissection flap at main artery obstructing origin of side-branch At times, the side branch could be compromised by thrombus too Different techniques of two stents by intention to treat bifurcation lesions The V stenting technique The simultaneous kissing stents technique The T stenting and modified T stenting technique The crush technique(The reverse crush technique/The step crush technique/The inverted crush technique) The culottes stenting technique The Y stenting technique The skirt technique The V stenting technique The simultaneous kissing stents technique The V stenting and the simultaneous kissing stenting technique 适合于分叉病变位于接近开口的血管近端，例如位于左主干的分叉病变，并且左主干短或无病变。理想夹角90°。 V支架也适合于其他部位的分叉病变，近段无病变或无须支架。 The V stenting and the simultaneous kissing stenting technique 优