ivus在lm介入治疗中的应用.ppt

IVUS在LM介入治疗中的应用,首都医科大学附属北京友谊医院王雷,LM-PCI面临的特殊挑战:,CAG提供的左主干病变程度、长度欠精确LMd-LADo-LCXo的斑块分布决定分叉病变干预策略位于“冠脉树”根部的LM生理特征变异大，纤维组织丰富，弹性强LM的PCI过程必须迅速精确、支架置入完美血管内超声提供更多帮助,IVUSGuidedLM-PCI,IVUS更清楚显示LM病变部位和程度IVUS决定LMd病变治疗策略IVUS改善LMd病变治疗效果,PrevalenceofLMSS,IVUS:themostusefulintracoronarydiagnostictoolinthecathlab,IVUS-LADo-LMdLesiondistribution,贾三庆，张宇晨，王雷，等.中华实用内科杂志，2019，4（14）7-9.,IVUS-LMLesionLocalizationPatients(n=75),OnlyOstial21%,OnlyMidShaft13.1%,OnlyBifurcation65.5%,FromCostantinoCostantinietal.,LMBifurcation-IVUSClassification,CAG14.89%4.27%10.63%29.78%IVUS34.04%6.38%10.63%25.53%,CAG8.51%17.02%14.89%IVUS4.27%12.76%6.38%,FromCostantinoCostantinietal.,47Bifurcations,IVUS-LMPlaqueDistribution,OviedoC,MaeharaA,MintzGS,etal.Circulation.2019Mar2.Epubaheadofprint,IVUS-LMPlaqueDistribution,OviedoC,MaeharaA,MintzGS,etal.Circulation.2019Mar2.Epubaheadofprint,IVUSdeterminantsofLMFFR0.75,Jastietal.Circulation2019;110:2831-6,IVUSCriteriaforaSignificantLMCAStenosis,MostIVUSLMCAstudiesshoweitherinsignificantdiseaseorcriticaldiseaseAbsolutelumenCSA6.0mm2(orMLD3.0mm)isthesuggestedcriterionforasignificantLMCAstenosisCorrelateswithaLMCAFFR0.75MurraysLaw(LMCAr3=LADr3+LCXr3)Doesnotdependonfindingadisease-freereferencesegmentItisnotclearwhetherthesamecriteriashouldbeusedforostialLMlesionsasformid-shaft/distalbifurcationlesionsandforpositivelyvsnegativelyremodeledlesions,-FromGarySMintz-TCT2009,Conclusions:IVUSguidedstentingreducedlong-termmortalityratecomparedwithconventionalangiography-guidedstentinginDESplacementforunprotectedLMCAstenosisThedifferentialsurvivalratebetweenIVUS-versusangiogrphyguidancestarttoseparateandprogressivelydivergedafter1yearTherefore,thereductioinoftheriskofverylatestentthrombosisbyIVUS-guidancemightplayaroleinimprovingsurvivalafterDESplacement,EffectofIVUSuponMortalityofLMStentingn=201pairs(BMS+DES),EffectofIVUSuponDeathorMIofLMStentingn=201pairs(BMS+DES),EffectofIVUSuponTVRofLMStentingn=201pairs(BMS+DES),EffectofIVUSuponMortalityofLMStentingn=145pairs(DES),对LM进行血运重建的IVUS标准:,最小管腔面积6mm2管腔面积狭窄率50%最小腔径(MLD)2.8mm,LM成功支架置入的IVUS标准:,完全贴壁:沿支架置入段支架完全帖靠血管壁对称均匀:支架最大直径比最小直径0.7扩张充分:支架最小腔面积(CSA)比平均参考血管腔面积0.9,LM-CasePresentationinRecentWork,CASE01,？,57yrsManUAP,Case01,Case01,Case01,Case01-FinalResult,Case02,54yrsManSTEMI(AnteriorWall)Postinfarctionagina,Case02,Case02,Case02,Case02,Case02-FinalResult,Conlcusions,PreinterventionIVUSismandatoryiftechnicallypossible1.Importantqualitativeandquantitativeinformationpermitbestapproach