罗建方-“拘禁”球囊分支保护技术.ppt

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1、SideBranchProtection:JailedBalloonTechnique“拘禁”球囊分支保护技术LuoJianfang罗建方GuangdongGeneralHospitalDonotlossSB!?YourStrategy?Two-stentTstentVstentCrushcullotededicatedstent?Provisionalstenting?Crossoverandfinalkissing?Toosmallvessel!ProvisionalstentingSte

2、ntingoftheSBmayberequiredinupto51%.MBstentingcancauseplaqueshift,spasm,protrusionofthestentstrutsintotheSBChangesinthebifurcationangleThejailedballoontechnique(JBT)isanovelmodifiedprovisionalstentingtechniquethataimstomaintainSBpatencyandimproveSBaccess.

3、JailedBalloonTechniqueBothlimbsofthebifurcationareaccessedwith0.014“wirePredilatationoftheMBwithastandardsemicompliantballoonStep1Step23.AmonorailballoonthatissizedtoapproximatetheSBvesseldiameter(generally1.5–2.0mmandofadequatelength)Theproximalmarkerof

4、theSBballoonispositionedapproximately(0-2mm)proximaltothestentStep3JailedBalloonTechnique4.TheMBstentisdeployedtonominalpressures,jailingtheSBwireandballoonStep4JailedBalloonTechnique5.IftheSBhasnotbeencompromised(i.e.,TIMI3flow),thenthetrappedSBballooni

5、sinflatedtolowpressure(<6ATMs)IfthereislessthanTIMI3flowintheSB,routineballoonangioplastyisperformedbeforetheballoonandwireareremovedJailedBalloonTechniqueStep5Keepstentballooninitialposition!6.TheMBstentballoon’spositionismaintainedcarefullyduringSBball

6、oonremovalJailedBalloonTechniqueStep67.Thestentballoonisthenfullyexpandedtomoderateorhighpressure,optimizationofMBstentapposition,andtocorrectanystentdeformationasaresultofthejailed-ballooninflationJailedBalloonTechniqueStep78.Finalangiographywillthenrev

7、ealwhetherornotrecrossingthroughthestentstrutsintotheSBisnecessaryforprovisionalangioplastyand/orstenting.JailedBalloonTechniqueStep8LongTermOutcomeSomeFindingsTheSBjailedballoonwasremovedinallpatientswithoutdamageorentrapmentoftheballoon.JBTdidnotleadto

8、anyMBstentstrutfracturesOnlyonepatienthadstentdeformation(IVUS)ReexpansionoftheMBstentballoonafterremovingthejailed-balloondidnotcausesignificantplaqueshift.FlowmodelfindingJBTKBThecaseJBT2.0*20predalitation2.0*20stent3.0*