分叉病变介入治疗我的课件

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1、分叉病变介入治疗天津市第三中心医院心脏中心刘迎午ContentDefinitionofbifurcationlesionClassificationofbifurcationlesionStrategyofbifurcation---onestentortwostentsSpecificstentforbifurcationClinicalcasesdefinition累及到冠状动脉分叉的病变冠状动脉病变中分叉病变较为常见，约占经皮冠状动脉介入治疗(pereutaneouscoronaryintervention，PCI)的15％~20％分叉病变的解剖结构(斑块负荷、斑块

2、位置、血管角度、血管直径、分叉位置)千变万化．而治疗过程中解剖结构也会随时改变(斑块迁移、血管夹层)所以无两个完全一致的分叉病变，更无一种可适用于所有分叉病变的手术方法ClassificationClassificationofbifurcationlesionsaccordingtoplaqueburdenA:DukeB:SanbornC:SafianD:LefevreMedinaA.etal.RevEspCardiol.2006;59:183-4ANewClassificationofCoronaryBifurcationLesions-MedinaClassific

3、ation1,1,11,1,01,0,10,1,11,0,00,1,00,0,1MBDistalMBProximalSB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(especiallyMI/thrombosis)分叉病变介入治疗-关注热点Stentingforbifurcationlesionsin2007主支放支架，分支临时决定StentingthemainvesselwithprovisionalstentingofthesidebranchProvisionalStentingStrategyIf2nd

4、stentisneededforsidebranchfollowingmainvesselstentingModifiedT-stentingReversecrushingCulottestenting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SidebranchclosureafterPCISide-branchmaybecompromisedfollowingmainvesselstentingPre-treatmentAfterstentingPlaque

5、shifting(“Snow-plow”)OstialspasmorSide-branchcompromisebystentmaterialDissectionofplaqueatoriginofside-branchDissectionflapatmainarteryobstructingoriginofside-branchAttimes,thesidebranchcouldbecompromisedbythrombustooDifferenttechniquesoftwostentsbyintentiontotreatbifurcationlesionsTheVst

6、entingtechniqueThesimultaneouskissingstentstechniqueTheTstentingandmodifiedTstentingtechniqueThecrushtechnique(Thereversecrushtechnique/Thestepcrushtechnique/Theinvertedcrushtechnique)TheculottesstentingtechniqueTheYstentingtechniqueTheskirttechniqueTheVstentingtechniqueThesimultaneouskis

7、singstentstechniqueTheVstentingandthesimultaneouskissingstentingtechnique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。TheVstentingandthesimultaneouskissingstentingtechnique优点:保证不会丢失分支。对吻技术时无须re-crossanystent.TheVstentingandthesimul