左主干病变的介入治疗.ppt

左主干病变的介入治疗冠心病分册编写人员名单LM病变的概念LM病变分类分类－－按部位分类－－按侧枝有保护左主干病变无保护左主干病变无保护左主干（ULMCA）病变的特点ULMCA不同治疗方法的临床疗效评价冠状动脉旁路移植术（CABG）单纯球囊成形术（PTCA）FirstPCIofLeftMainintheWorld冠脉内支架术左主干病变PCI：ACC/AHA/ESC指南实践－DESinLMRegistries左主干：BMSvsCABG左主干：DESvsCABGClinicalOutcomesupto4yearsLMSubsetLMPCI所面临的问题Syntax:goodpredictiveabilityinthePCIscenario,whilepoorinCABGscenarioImprovedAUCofCSScomparedwithSyntaxscoreorACEFscoreEuroScoreSystemTheGlobalRiskClassification(GRC)Comparisonofdifferentriskmodels---GRCscorehadthehighestpredictivevalueComparingdifferentriskscoreforLMrevascularization:Syntax,EuroScore,CSS,GRC左主干病变介入治疗的适应症和禁忌症有保护左主干病变无保护左主干病变适应症无保护左主干病变相对禁忌症左主干病变理想的暴露体位左主干开口左主干开口LM体部/干段LM体部/干段LM末端LM末端器械选择及手术技巧手术路径---与选择的器械大小及病变特点有关导引导管---不影响冠脉灌注、避免损伤血管为原则导引导丝---良好地支持球囊---充分预扩张支架---良好的支撑不同病变的处理原则LM-PCI－－左主干开口病变LM-PCI－－左主干开口病变Angiography:howtoengagethecatheterintotheLM-stentwhichprotrudeintoaorta?LMOstiumStentPositionHowtoEnsureStentPositioningAccurately?StentpositioninLMostiumLMOSTIUMHowtoevaluatestentappositionwithoutIVUS?LM-PCI－－左主干干段病变LM-PCI－－左主干远端分叉病变Howtoselectthestentdiameter?BifurcationnaturalbranchinglawsWhataboutLMdiameter?DilationLimitafterPostdilationDoublestenttechnique-1KissStentingKissstenting:asymmetricalmetaloverlapanddoublelumenInsightsIntotheCrushTechniqueCrushTechniqueTheCrushTechniqueInsightFromBenchReachtheCarena&FittheanatomyDoublestenttechnique-2CompletecoverageoftheSBostiumisstillachallengefor“T”stentingCulotteTechniqueIntravascularUltrasoundClassificationofPlaqueDistributioninLeftMainCoronaryArteryBifurcations动脉粥样硬化斑块好发于分叉处，嵴较少累及TreatmentofSBcompromiseplaqueshiftvs.carinashiftBifurcationangleandlong-termoutcomeLMCAbifurcationangleSYNTAX:MACCEto3Years≥2stentsinLMBi/TrifurcationLMCAbifurcationangle影响无保护左主干介入治疗成功率的因素术前、术后处理术前术后处理病例及病例讨论病例1病例1病例1病例1病例2病例2病例2病例2病例2病例3病例3病例3病例3目前的问题及建议箴言谢谢！