严重钙化病变pci治疗王海昌.pptVIP

Application of Percutaneous Coronary Intervention for Severe Calcification Lesions ;;Culprit and Healed Plaques in a Coronary Bifurcation;Epidemiology ;; Angiogram cannot detect calcifications (CAG) Ultrafast computed tomography (CT scanning) can measure arterial calcification (noninvasive) Intravascular Ultrasound （IVUS） Optical Coherence Tomography (OCT);;;Calcified coronary plaques imaged in vivo by optical coherence tomography (OCT) and intravascular ultrasound (IVUS);Non-invasive Quantification for Calcified Lesions by CT Scan;;;“中－重度钙化（B型）病变是导致冠状动脉球囊成形术（PTCA）手术失败和血管急性闭塞的主要危险因素” — 1988年ACC/AHA心血管诊治技术评价的报告;钙化病变介入治疗;钙化病变单纯PTCA的局限性;Case 1 ( Balloon + DES);Case 1 ( Balloon + DES);Case 1 ( Balloon + DES);球囊成形术（PTCA）;Initial Reaction :Fear ;Atherectomy ;Laser;Rotablator : rotational atherectomy catheter;Rotablator Syetem ;Rotablation is recommended for fibrotic or heavily calcified lesions that can be wired but not crossed by a balloon or adequately dilated before planned stenting. One must know how to manage the complications inherent to rotablation. ;钙化病变的分类;DES时代钙化病变治疗的要点; STRTAS ( Study To Determine Rotablator and Transluminal Angioplasty Strategy ) 初步结果显示，采用更大的磨头和较长的旋磨时间进行强烈的消蚀与更保守的消蚀方法相比，并没有改善即刻和远期效果。 旋磨＋支架（rotastent）能得到最大的管腔和最小的残余狭窄。;钙化病变介入治疗的难点（I）;钙化病变介入治疗的难点（II）;Case2：Severe Calcification and Balloon Suboptimal Dilation lead to Acute Stent Thrombosis;Case2：Severe Calcification and Baloon Suboptimal Dilation lead to Acute Stent Thrombosis;Female，76yrs Exertional chest pain 8yrs, recurrent 10days EF:40% ;Cutting Balloon: 2.5*10 (16ATM, 20) Post dilate balloon: 2.5＊13 (18ATM, 12);Guiding ： 6F EBU3.5Guide Wire： Stablizer/ PT2MS Bur: 1.5mm Rotor rate ： 160000 rpm;2.5＊24 TAXUS(10ATM, 8) 2.75＊28 TAXUS(12ATM, 7);钙化病变的器械选择（I）;钙化病变的器械选择（II）;钙化病变的操作要点（I）;132 patients – at least one moderate-severely calcified lesion on fluoroscopy Rotablation/DES vs DES alone Primary endpoint – 8 month binary angiographic restenos