复杂冠脉分叉病变的PCI治疗策略ppt课件.ppt

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1、PCIStrategiesforComplexCoronaryBifurcationlesions首都医科大学附属北京安贞医院周玉杰聂斌BeijingAnzhenHospitalOneortwostents?NordicBifurcationStudy(n=413)413ptswithbifurcationlesionStentingofthemainvesselandsidebranch(MV+SB)Stentingofthemainvesselandoptionalstentingofthesidebranch(MV)n=

2、206n=207RandomizedPrimaryEndpoint:Majoradversecardiacevent(MACE)at6monthsPrimaryEndpointofMACEat6months(%)p=NSPresentedatACC2006Therewasnodifferenceinmajoradversecardiaceventsat6months(17.7%vs12.7%;p=NS)NordicBifurcationStudy(n=413)ProcedurerelatedMIwasdefinedasafiv

3、e-foldelevationofbiochemicalmarkersProcedurerelatedMIoccurredmorethanthreetimesasoftenintheMV+SBgroup(13%vs4%;p=0.008)ProcedureRelatedMyocardialInfarction(%)p=0.008PresentedatACC2006NordicBifurcationStudy(n=413)OneStentStrategyProvisionalTStentingProvisionalTStentPr

4、ovision-Tstenttechnique53pts,SB>2mmMACE9.4%at14+/-3monthsTLR3.8%,MVrestensosis3.2%,SB12.9%at6monthsVignaC,etal.JInvasiveCardiol.2007Mar;19(3):92-7.TheSBhasanarrowingatitsostiumTheMBhasseverestenosiswithalargeplaqueburdenandtheSBoriginateswithanangleof45°Theostiumoft

5、heSBdeterioratesafterpre-dilatationoftheMBAwireisneededinthefollowingcircumstances:ProvisionalTStentFKBisVeryImportantforProvisionalTStentProvisionalTStentTwoStentsTechniquesTstentCulotteSKSVstentProvisionalTModifiedTstentYstentBMSEraDESEraCrushReverseCrushBalloonCr

6、ushDKCrushMini-CrushInvertedCrushTstentTechniqueCulotteTechniqueClinicalOutcomesInBMSera,theincidenceofTLRwas24%at6months(Chevalier.AmJCardiol1998;82:943)InDESera,theincidenceofMACEwas5.3%andTLRwas15.4%(Hoye,etal.IntJCardiovascinterven2005;7:36)CulottevsTstentinDESe

7、ra80patientswithbifurcationlesionsCulottetechnique45casesTstent35casesTheproceduralsuccessrate100%TLR:8.9%P=0.014;9monthsMACE13.3%P=0.051KaplanS,etal.AmHeartJ.2007Aug;154(2):336-43Theproceduralsuccessrate100%TLR:27.3%9monthsMACE27.3%SKSTechniqueClinicalOutcome200pat

8、ientswithbifurcationlesionsSKStechniqueCypherstentsTheclinicalsuccessrateis97%TheincidenceofTLR:4%9+/-2monthsSharmaSK.CatheterizationandCa