复杂冠脉分叉病变的PCI治疗策略.ppt

PCIStrategiesforComplexCoronaryBifurcationlesions首都医科大学附属北京安贞医院周玉杰聂斌BeijingAnzhenHospital

Oneortwostents?

NordicBifurcationStudy(n=413)413ptswithbifurcationlesionStentingofthemainvesselandsidebranch(MV+SB)Stentingofthemainvesselandoptionalstentingofthesidebranch(MV)n=206n=207RandomizedPrimaryEndpoint:Majoradversecardiacevent(MACE)at6months

PrimaryEndpointofMACEat6months(%)p=NSPresentedatACC2006Therewasnodifferenceinmajoradversecardiaceventsat6months(17.7%vs12.7%;p=NS)NordicBifurcationStudy(n=413)

ProcedurerelatedMIwasdefinedasafive-foldelevationofbiochemicalmarkersProcedurerelatedMIoccurredmorethanthreetimesasoftenintheMV+SBgroup(13%vs4%;p=0.008)ProcedureRelatedMyocardialInfarction(%)p=0.008PresentedatACC2006NordicBifurcationStudy(n=413)

OneStentStrategyProvisionalTStenting

ProvisionalTStent

Provision-Tstenttechnique53pts,SB2mmMACE9.4%at14+/-3monthsTLR3.8%,MVrestensosis3.2%,SB12.9%at6monthsVignaC,etal.JInvasiveCardiol.2007Mar;19(3):92-7.

TheSBhasanarrowingatitsostiumTheMBhasseverestenosiswithalargeplaqueburdenandtheSBoriginateswithanangleof45°TheostiumoftheSBdeterioratesafterpre-dilatationoftheMBAwireisneededinthefollowingcircumstances:ProvisionalTStent

FKBisVeryImportantforProvisionalTStentProvisionalTStent

TwoStentsTechniquesTstentCulotteSKSVstentProvisionalTModifiedTstentYstentBMSEraDESEraCrushReverseCrushBalloonCrushDKCrushMini-CrushInvertedCrush

TstentTechnique

CulotteTechnique

ClinicalOutcomesInBMSera,theincidenceofTLRwas24%at6months(Chevalier.AmJCardiol1998;82:943)InDESera,theincidenceofMACEwas5.3%andTLRwas15.4%(Hoye,etal.IntJCardiovascinterven2005;7:36)

CulottevsTstentin