冠脉叉病变介入技巧.pptx

分叉病变介入技巧;Classificationofbifurcationlesionsaccordingtoplaqueburden;MedinaA.etal.RevEspCardiol.;59:183-4;一个好还是两个好？

假如选２个，应该采取何种策略?

策略选择依据

简单化vs复杂化

循证结果vs个人选择

并发症率(especiallyMI/thrombosis)

;Stentingforbifurcationlesionsin;ProvisionalStentingStrategy

;分支血管保护与放置支架;SidebranchclosureafterPCI;Side-branchmaybecompromisedfollowingmainvesselstenting;Differenttechniquesoftwostentsbyintentiontotreatbifurcationlesions;TheVstentingtechnique;Thesimultaneouskissingstentstechnique;TheVstentingandthesimultaneouskissingstentingtechnique;TheVstentingandthesimultaneouskissingstentingtechnique;TheVstentingandthesimultaneouskissingstentingtechnique;TheTstentingtechnique;ThemodifiedTstentingtechnique;TheTandmodifiedTstentingtechnique;ColomboetalCirculation;109:1244-1249;RESEARCHbifurcationsubgroup;VstentingvsTstenting;ProvisionalTstenting;优点:

Higherproceduralsuccessrate

Lowerexpense

Lowercomplications

Lowerre-PCI

7monsTLR15%。

Lefevreetal:ProvisionalTstentingisthegoldenstandardtotreatfalsebifurcationlesion(tpye2,3and4a),mostsubjectsonlyneedonestentimplantation。;Thecrushtechnique;Thecrushtechnique;;;Thereversecrushorinternalcrushtechnique;Thereversecrushorinternalcrushtechnique;Thereversecrushorinternalcrushtechnique;Thestepcrushtechnique;Case:Thestepcrushtechnique;冠脉叉病变介入技巧;Firstkissing;冠脉叉病变介入技巧;Secondkissing;Finalresult;Thestepcrushtechnique;Theinvertedcrushtechnique;Theinvertedcrushtechnique;RestenosisinMV=12.2%

RestenosisinSB=2%;Theculottesstentingtechnique;Theculottesstentingtechnique;NordicBifurcationStudyII

-TheNordicStentTechniqueStudy

:CrushvsCulottestenting;NordicBifurcationStudyII

-TheNordicStentTechniqueStudy

:CrushvsCulottestenting;TheYstentingtechnique;Theskirttechnique;TheYstentingtechnique

andTheskirttechnique;TheYstentingtechnique;Cl