分叉病变介入技巧PPT.pptVIP

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. 分叉病变介入技巧广东省人民医院谭 宁 Classification of bifurcation lesions according to plaque burden A:Duke B:Sanborn C:Safian D:Lefevre 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 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 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 优点: 保证不会丢失分支。 对吻技术时无须 re-cross any stent. The