药物涂层支架（DES）对我们临床实践的影响-香港.pptVIP

药物涂层支架（DES）对我们临床实践的影响 Dr Liang Chow, MD Hong Kong DES的应用 美国 21 23 25 65 90 ____________________________ 其它 地区 13 16 25 25 31 ____________________________ Q4 Q1 Q2 Q3 Q4 02 2003 如何处理 开口 左主干 分叉 完全闭塞 小血管 弥漫病变 长病变 大隐静脉桥 支架内再狭窄 急性冠脉综合征/急性心肌梗死 技术和技巧 左主干 4/03, Cypher用于分叉bifurcation allowed, ?crushed T Avoid EF30% IABP+/- Residual stenosis 20% IVUS useful 2b3a Debulk if mild calcification BMS-avoid T or Y stenting DO NOT overstretch DES 分叉病变 关键技术 Predilate SB +/- MB 6mm Cutting ballooon for SB Deploy according to Crushing Remove wire and balloon from SB Rewire SB Post dilate ostium of SB Final kissing 分叉 Provisional T stenting of SB Stent deformation Stent both branches with 1 stent Good effect if failed wiring False bifurcation Provisional T stenting with dedicated stent Focus on main branch 分叉病变效果 再狭窄率 POBA 62 48 BMS 51.3 33.3 Cypher 24 18.7 ____________________________________ S+S S+POBA (Colombo) 小血管/弥漫病变 Overlapping stents Long metal length Full metal jacket Risk of thrombosis 完全闭塞 大血管 Unavailability of stent Avoid overstretch DES Low restenosis rate with short lesion 糖尿病 SOS Lancet 2002 ARTS (3yr) SOS (1 yr) RESEARCH Registry (P Surreys) LIMA survival BARI-tolerate MI better Low risk DM, ?stabilise plague FREEDOM trial –CABG vs Cypher, DM with MVD 直接支架植入 Advantages-decrease procedural time, save cost Disadvantages-risk of stent jail, ?disruption of polymer Non-significant decrease in restenosis (P Surreys) No definite advantage In doubt – predilate E-SIRIUS –direct stenting allowed (8/18, max 2 stents) ISR 抗血小板策略 阿司匹林 + 波立维 时限 BMS 1 月 DES 3 月 6 月 (ISR, long36, multiple 3, bifurcation, CTO) 9 months 抗血小板和抗凝策略 CREDO-pre –treat plavix (Muller Heart 2001) ISR-REACT Synergy Replace II Plavix 600mg 24hr prior 300mg 6 hr prior 75 mg qd for 1 yr UFH in low risk group, ACT 250 Enoxaparine Bivalirudin (ACUITY)