经心房支逆向cart技术李悦课件

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1、李悦哈尔滨医科大学第一临床医学院CTO病变PCI一例经心房支逆向CART技术临床资料67岁男患劳累后胸痛6个月OMI(前壁,11Y),大量吸烟史(31Y)糖尿病史(10Y),脑梗塞史(偏瘫5Y)UCG:EF:44%;前壁室壁瘤ECG:病理性Q波(V1-V4)LAD、LCXCTORAO+CAULAD、LCXCTORAO+CRARCACTO(ostialocclusion)Strategy:CABG&PCILAD&LCX&RCA?Strategy:Antegrade&Retrograde?StumpabsentOcclusionatside-branchLCXRCA（a

2、trialchannel）CC2/Rentrop2首选前向PCIFielderFCFinecross1.8FFielderFCConquestProRetrogradeproximaltruelumenpunctureFalselumenFalselumen?HowtodoKissingwiretechniqueAntegrade(ConquestPro)FalselumenHowtodo?Controlledantegradeandretrogradesubintimaltracking(CART)逆向球囊扩张后便于前向导丝进入远端真腔。Ryujin1.5×15m

3、m6atmCARTRyujin2.5×20mmPredilationConquestProRunthroughFirebird3.0×33mmFirebird3.5×18mmPost-PCIHomemessage什么情况下首选逆向技术？“theeasiestisthebest”前向失败(CTOspecializedguidewireandtechnique）前向PCI技术难度大(Stumpabsent、Occlusionatside-branch）对侧供血血管没有明显病变且侧枝好2008TCT哪种侧枝更好?心房支Microcatheter（Fincross、Prog

4、eat、Transit、Prowler10、Excelsior10）2.4F2.8F1.8FGuidewire(retrograde)precisetipshapingduetoitsshortsoldering超选造影有助于适合选择侧枝便于逆向导丝通过FielderFCConquestProRetrogradeproximaltruelumenpuncture?Miracle3AfailedCTOPCIisalwaysbetterthanacomplicationLiYue,M.D.TheFirstAffiliatedHospitalofHarbinMedical

5、UniversityviaatrialcollateralandCARTtechniqueAcaseofCTOPCIusingretrogradeapproachClinicalData67-year-oldmanChestpainwitheffortfor6monthsOMI(anteriorwall,11Y),Heavysmoking(31Y)DM(10Y),IschemicStroke(hemiplegia5Y)UCG:EF:44%;anteriorwallaneurysmECG:PathologicQwave(V1-V4)LAD、LCXCTORAO+CAUL

6、AD、LCXCTORAO+CRARCACTO(ostialocclusion)Strategy:CABG&PCILAD&LCX&RCA?Strategy:Antegrade&Retrograde?StumpabsentOcclusionatside-branchLCXRCA（atrialchannel）CC2/Rentrop2RetrogradeasfirstchoiceFielderFCFinecross1.8FFielderFCConquestProRetrogradeproximaltruelumenpunctureFalselumenFalselumen?H

7、owtodoKissingwiretechniqueAntegrade(ConquestPro)FalselumenHowtodo?Controlledantegradeandretrogradesubintimaltracking(CART)Retroballoonbedilatedtomakespaceforanteguidewireeasilyreachdistaltruelumen.Ryujin1.5×15mm6atmCARTRyujin2.5×20mmPredilationConquestProRunthroughFirebird3.0×33mmFir