支架的最优化释放.pptxVIP

支架的最优化释放会计学第2页/共22页Predictors of DES Thrombosis RestenosisDES ThrombosisDES RestenosisUnderexpansionFujii et al. J Am Coll Cardiol 2005;45:995-8)Okabe et al., Am J Cardiol. 2007;100:615-20Sonoda et al. J Am Coll Cardiol 2004;43:1959-63Hong et al. Eur Heart J 2006;27:1305-10TAXUS IV, V, VI meta-analysisFujii et al. Circulation 2004;109:1085-1088Edge problems (geographic miss, secondary lesions, large plaque burden, etc)Fujii et al. J Am Coll Cardiol 2005;45:995-8)Okabe et al., Am J Cardiol. 2007;100:615-20Sakurai et al. Am J Cardiol 2005;96:1251-3Liu et al, Am J Cardiol, in pressCosta et al, Am J Cardiol, 2008;101:1704-11 暴露的支架第3页/共22页由 LIA结果判断后期支架血栓形成使用 DES支架的LaST的病例44岁的男性因急性心梗住院, 为最初的DES支架植入31 个月后完全闭塞Eur Heart J. 21 Oct 2005.第4页/共22页Stenting and Post-DilatationThe POSTIT Trial71% 的病人没有达到理想的支架贴壁1（n=256)% Patients Meeting IVUS Criteriafor Sub-Optimal Stent Deployment12mm12mm70%70%3mm3mmLesion Length% StenosisAverage RVD 造影没有预示亚理想的贴壁, 包括:- 病变长度 - 狭窄百分率 - 参照血管直径 - 支架的类型 1 Brodie, et al. Final Results From The POSTIT Trial. Catheterization and Cardiovascular Interventions 2003; 59: 184-192, Table 3Copyright ?2004 by Boston Scientific Corporation or its affiliates. All rights reserved. Information for the use only in countries with applicable health authority product registrations.应该后扩第5页/共22页POSTIT研究:29％， IVUS36%， 12atmMSA/MLD：p0.0011/3* MSA ：最小支架面积* MLD：最小管腔直径* 两者为衡量支架是否充分贴壁的指标X 10 Dilatation ForcePressure x Diameter2 x Wall ThicknessF=第6页/共22页Inflation pressure and dilatation force3mm0.5mm1mm1.5mmCypher 3.0x33mm第7页/共22页Jailed wires for side-branch protectionside branches are selectively wiredSide-Branch protectionBaselineIf SBs remain open without protection it means that the stent is not fully expanded !!12391/05第8页/共22页第9页/共22页支架的最优释放保证病人的远期预后第10页/共22页FIRE STAR? Rx PTCA BalloonFIRE STAR is designed to provide “Crossability with Accuracy” 优异的通过性能精确预扩张性能第11页/共22页优异的通过性能?? Lowest Profile 最小的通过外径FIRE STAR? 具有最小通过外径,专为复杂病变设计第12页/共22页精确扩张性能 8 atm No