冠脉分叉病变介入技巧.ppt

The step crush technique Case: The step crush technique First kissing Second kissing Final result The step crush technique 优点: 6F guiding catheter可以完成操作，特别适合于桡动脉经路，第二次导丝和球囊再次通过较容易成功。 缺点: 同 the standard crush technique. The inverted crush technique The inverted crush technique 适用于分支管径不小于主支的情况。 分支支架挤压crush主支支架。 缺点: 同 the standard crush technique. Restenosis in MV = 12.2% Restenosis in SB = 2% Galassi et al. Cath Cardiovas. Intervn 2007; 69: 976-83 The culottes stenting technique The culottes stenting technique 优点: 适合于任何角度的分叉病变，并提供完美的分支开口覆盖。 缺点: 分叉病变近段双层支架重叠，金属密度高。 Nordic Bifurcation Study II - The Nordic Stent Technique Study : Crush vs Culotte stenting Nordic Bifurcation Study II - The Nordic Stent Technique Study : Crush vs Culotte stenting Individual end-point at 6 months The Y stenting technique The skirt technique The Y stenting technique and The skirt technique 优点: 这是最后一种治疗分叉病变的方法，适用于非常复杂的分叉病变并要求保证导丝进入两分支。 缺点: 近端支架释放系统需要改良，手工将支架捻在双球囊上。应用DES易破坏polymer 。 近端支架很难完全连接远端双支架。 采用Y 支架技术时，多数术者将分支导丝回撤并放入主支，这时释放近端支架可以更好连接远端支架 The Y stenting technique 77 case being with bifurcation lesions received the Y stenting therapy and 6 mons follow-up results:RR 36%, TLR 30%。 Maillard L, Guerin L, Drieu L, et al. Am J Cardiol 1998;82:7A–50S Classification of bifurcation lesions according to plaque burden A:Duke B:Sanborn C:Safian D:Lefevre The V stenting technique The simultaneous kissing stents technique The T stenting and modified T stenting technique The crush technique(The reverse crush technique/The step crush technique/The inverted crush technique) The culottes stenting technique Each lesion must be approached therapeutically in the context of its own anatomy. * 分型依据：主支与边支成角、病变斑块负荷 Y型病变：成角70，但斑块负荷移位比较大 T型病变：成角70，但斑块负荷移位往往较小 上述分型均存在这样缺点：没有考虑到在扩张主支血管时边支血管会发生什么情况；因此每一个分叉病变应根据具体解剖情况决定手术方式！ * If there is a need to place a stent at the proximal segment of a vessel treated with V stenting, there are two options: 1) a stent is placed proxi-mally, leaving a small gap b