冠脉分叉病变介入技巧.pptVIP

The step crush technique 冠脉分叉病变介入技巧 Case: The step crush technique 冠脉分叉病变介入技巧 冠脉分叉病变介入技巧 First kissing 冠脉分叉病变介入技巧 冠脉分叉病变介入技巧 Second kissing 冠脉分叉病变介入技巧 分叉病变介入技巧 冠脉分叉病变介入技巧 Classification of bifurcation lesions according to plaque burden A:Duke B:Sanborn C:Safian D:Lefevre 冠脉分叉病变介入技巧 Medina A. et al. Rev Esp Cardiol. 2006; 59: 183-4 A New Classification of Coronary Bifurcation Lesions - Medina Classification 1, 1, 1 1 , 1, 0 1, 0 , 1 0, 1, 1 1, 0, 0 0, 1, 0 0, 0, 1 MB Distal MB Proximal SB 冠脉分叉病变介入技巧 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 冠脉分叉病变介入技巧 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 冠脉分叉病变介入技巧 Provisional Stenting Strategy If 2nd stent is needed for side branch following main vessel stenting Modified T-stenting Reverse crushing Culotte stenting 冠脉分叉病变介入技巧 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 冠脉分叉病变介入技巧 Side branch closure after PCI 冠脉分叉病变介入技巧 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 冠脉分叉病变介入技巧 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 冠脉分叉病变介入技巧 The V stenting technique 冠脉分叉病变介入技巧 The simultaneous kissing stents technique 冠脉分叉病变介入技巧 The V stenting and the simultaneous kissing stenting technique 适合于分叉病变