資源描述：
《冠脈分叉病變介入技巧課件》由會員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫。
1、分叉病變介入技巧ClassificationofbifurcationlesionsaccordingtoplaqueburdenA:DukeB:SanbornC:SafianD:LefevreMedinaA.etal.RevEspCardiol.2006;59:183-4ANewClassificationofCoronaryBifurcationLesions-MedinaClassification1,1,11,1,01,0,10,1,11,0,00,1,00,0,1MBDistalMBProximalSB一個(gè)
2、好還是兩個(gè)好？如果選２個(gè)，應(yīng)該采取何種策略?策略選擇的根據(jù)簡單化vs復(fù)雜化循證結(jié)果vs個(gè)人選擇并發(fā)癥率(especiallyMI/thrombosis)分叉病變介入治療-關(guān)注熱點(diǎn)Stentingforbifurcationlesionsin2007主支放支架，分支臨時(shí)決定StentingthemainvesselwithprovisionalstentingofthesidebranchProvisionalStentingStrategyIf2ndstentisneededforsidebranchfollowin
3、gmainvesselstentingModifiedT-stentingReversecrushingCulottestenting分支血管的保護(hù)與放置支架并非所有分支血管同等重要!根據(jù)以下情況實(shí)施分支血管保護(hù)和支架植入分支血管大小與分布區(qū)域分支血管開口病變與病變程度分支與主支成角程度SidebranchclosureafterPCISide-branchmaybecompromisedfollowingmainvesselstentingPre-treatmentAfterstentingPlaqueshifti
4、ng(“Snow-plow”)OstialspasmorSide-branchcompromisebystentmaterialDissectionofplaqueatoriginofside-branchDissectionflapatmainarteryobstructingoriginofside-branchAttimes,thesidebranchcouldbecompromisedbythrombustooDifferenttechniquesoftwostentsbyintentiontotreatbi
5、furcationlesionsTheVstentingtechniqueThesimultaneouskissingstentstechniqueTheTstentingandmodifiedTstentingtechniqueThecrushtechnique(Thereversecrushtechnique/Thestepcrushtechnique/Theinvertedcrushtechnique)TheculottesstentingtechniqueTheYstentingtechniqueTheski
6、rttechniqueTheVstentingtechniqueThesimultaneouskissingstentstechniqueTheVstentingandthesimultaneouskissingstentingtechnique適合于分叉病變位于接近開口的血管近端，例如位于左主干的分叉病變，并且左主干短或無病變。理想夾角<90°。V支架也適合于其他部位的分叉病變，近段無病變或無須支架。TheVstentingandthesimultaneouskissingstentingtechnique優(yōu)點(diǎn):保
7、證不會丟失分支。對吻技術(shù)時(shí)無須re-crossanystent.TheVstentingandthesimultaneouskissingstentingtechnique缺點(diǎn):雙支架近端定位較困難；不可避免造成其中一個(gè)支架偏心，往往引起agap。TheTstentingtechniqueThemodifiedTstentingtechniqueTheTandmodifiedTstentingtechnique優(yōu)點(diǎn):較crush技術(shù)容易完成。缺點(diǎn):大多數(shù)情況下，分支開口不能完全覆蓋。ColomboetalCircul
8、ation2004;109:1244-1249*Highcross-overratefromStent+BalloontoStent+Stentgroup(22/43,51%)CypherBifurcationStenting(T-stenting)EffectsoftheTstentingtechniqueRESEARCHbifurcatio
