ivus在lm介入治疗中的应用-课件，幻灯

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1、IVUS在LM介入治疗中的应用首都医科大学附属北京友谊医院王雷LM-PCI面临的特殊挑战:CAG提供的左主干病变程度、长度欠精确LMd-LADo-LCXo的斑块分布决定分叉病变干预策略位于“冠脉树”根部的LM生理特征变异大，纤维组织丰富，弹性强LM的PCI过程必须迅速精确、支架置入完美血管内超声提供更多帮助IVUSGuidedLM-PCIIVUS更清楚显示LM病变部位和程度IVUS决定LMd病变治疗策略IVUS改善LMd病变治疗效果PrevalenceofLMSSIVUS:themostusefulintracoronarydiagnostictoolinthecathlabI

2、VUS-LADo-LMdLesiondistribution贾三庆，张宇晨，王雷，等.中华实用内科杂志，2002，4（14）7-9.IVUS-LMLesionLocalizationPatients(n=75)OnlyOstial21%OnlyMidShaft13.1%OnlyBifurcation65.5%FromCostantinoCostantinietal.LMBifurcation-IVUSClassificationCAG14.89%4.27%10.63%29.78%IVUS34.04%6.38%10.63%25.53%CAG8.51%17.02%14.89%IV

3、US4.27%12.76%6.38%FromCostantinoCostantinietal.47BifurcationsIVUS-LMPlaqueDistributionOviedoC,MaeharaA,MintzGS,etal.Circulation.2010Mar2.[Epubaheadofprint]IVUS-LMPlaqueDistributionOviedoC,MaeharaA,MintzGS,etal.Circulation.2010Mar2.[Epubaheadofprint]IVUSdeterminantsofLMFFR<0.75Jastietal.Circu

4、lation2004;110:2831-6IVUSCriteriafora‘Significant’LMCAStenosisMostIVUSLMCAstudiesshoweitherinsignificantdiseaseorcriticaldiseaseAbsolutelumenCSA<6.0mm2(orMLD<3.0mm)isthesuggestedcriterionforasignificantLMCAstenosis•CorrelateswithaLMCAFFR<0.75•Murray’sLaw(LMCAr3=LADr3+LCXr3)•Doesnotdependonfi

5、ndingadisease-freereferencesegment•ItisnotclearwhetherthesamecriteriashouldbeusedforostialLMlesionsasformid-shaft/distalbifurcationlesionsandforpositivelyvsnegativelyremodeledlesions------FromGarySMintz-TCT2009Conclusions:IVUSguidedstentingreducedlong-termmortalityratecomparedwithconventiona

6、langiography-guidedstentinginDESplacementforunprotectedLMCAstenosisThedifferentialsurvivalratebetweenIVUS-versusangiogrphyguidancestarttoseparateandprogressivelydivergedafter1yearTherefore,thereductioinoftheriskofverylatestentthrombosisbyIVUS-guidancemightplayaroleinimprovingsurvivalafterDES

7、placementEffectofIVUSuponMortalityofLMStentingn=201pairs(BMS+DES)EffectofIVUSuponDeathorMIofLMStentingn=201pairs(BMS+DES)EffectofIVUSuponTVRofLMStentingn=201pairs(BMS+DES)EffectofIVUSuponMortalityofLMStentingn=145pairs(DES)对LM进行血运重建的IVUS标准:最小管腔面积≥6