冠脉旋磨术适应证的选择课件

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1、冠脉旋磨术适应证的选择RotationalAtherectomyDevelopedearly1980s,DavidAuthPhDduring‘newdeviceera’Uniqueoperatingprinciple–differentialcuttingofinelastic(calcified/fibrotic)tissueFallfromfavour/uselate1990s–1.unfavourablerestenosisdata(ERBAC,ARTIST)2.regardedastime-consumingtouse冠脉旋磨术适应证的选择为什么要选择冠脉

2、旋磨术？如何选择适应证？冠脉旋磨术中需要注意的几个问题Duringpastfewyears,scopeofPCIhasadvancedgreatly,includingseveralsubsets:Complex,calcifiedlesionsVeryelderlypatients(10%JGMPCIpts>80yrs)Patientswithextensivecomorbidity(CRFetc)turneddownforCABGthatprovideresurgentroleforRotablatorinimprovingproceduraloutcome.

3、In2006,55RAof462totalPCIs(11.9%)Istherecontemporaryevidencetosupportthispractice?时代不同了RandomisationOfCalcifiedCoronaryStenosestoTAxusstentingwithorwithoutRotationalatherectomy132patients–atleastonemoderate-severelycalcifiedlesiononfluoroscopyRotablation/DESvsDESalonePrimaryendpoint–8m

4、onthbinaryangiographicrestenosisSecondaryendpoints–proceduralsuccess/MACE;acute/subacute/latestentthrombosisROCCSTARTrialROCCSTAR–recruitmenttodate113patients57Roto/DES56DESalone34large23small34large22small(3mmor>)92%angiographicfollowupInarrivingat56ptsinDESalonelimb,of64ptsintendedf

5、orthislimb,8(12.5%)unabletopredilatefully(placedinROCCSTARRotablatorregistry)Subacutestentthrombosis2/56(3.6%)inDESalonelimb(bothinsmallvessels)vs0/57inRoto/DESlimbROCCSTAR–2observationstodatereimpactofRotablationonproceduraloutcomeincalcifiedlesions冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？如何选择适应证？冠脉旋磨

6、术中需要注意的几个问题ImproveproceduraloutcomeExpandindicationsofPCIBalloonundilatableoruncrossablelesions,especiallywithsuperficialcalcificationOstiallesions,particularlyaorto-ostialstenosisBifurcationlesionsLonglesions<25mm,especiallywithcalcificationContraindicationsThrombus-containinglesion

7、sDegeneratedsaphenousveingraftsLonglesions>25mmFDA的建议冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？如何选择适应证？冠脉旋磨术中需要注意的几个问题指引导管/磨头兼容性*an.004”clearanceisrecommended支架扩张术旋磨支架术Case160yrs,MSmokingfamilyhistoryHypertensionDMnon-QAMIhistorymildeffortdyspneaSPECT:antero-septal&lateralperfusiondefects围手术期抗栓ASA：100mg

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