CTO介入治疗策略的选择.ppt

CTO介入治疗策略的选择 复旦大学附属中山医院心内科上海市心血管病研究所葛雷 DualCatheterAngiography ClearproximalcapGoodDistalTarget 3 Length 20mm Antegrade Retrograde yes no Wireescalation DissectionReentry crossboss stingray Wireescalation DissectionReentry reverseCART yes yes no no BrilakisESetal JACCCardiovascInterv2012 TheHybridAlgorithmforCTOPCIinUSA CTO介入治疗策略的选择 仅仅评价了CTO正向的解剖结构 对侧枝血管的评估不够正向技术和逆向技术的相互转化条件不够细化忽略了平行导引钢丝技术忽略了IVUS在CTOPCI中的作用过分强调了ADR技术 CTO介入治疗策略的选择 一百个观众心中就有一百个哈姆雷特 与之相似 不同的术者 就有不同的手术策略 尽管手术策略多种多样 但仍然有规律可循 Carefulanalysisofcoronaryangiogram MSCT Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 060235 Case1 Male 47yrs Tinystump healthydistalvessel length 20mm CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 060235 Corsair FielderXT CTO介入治疗策略的选择 060235 GaiaFirst CTO介入治疗策略的选择 060235 StentingandFinalResult CTO介入治疗策略的选择 68323 Case2 Male 69yrs CTO介入治疗策略的选择 68323 CTO介入治疗策略的选择 68323 7FEBU3 5 CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 68323 KDL Crusade Sion CTO介入治疗策略的选择 68323 IVUS iLab Frame CTO介入治疗策略的选择 68323 Frame GAIASecond 130cmFineCross CTO介入治疗策略的选择 68323 CTO介入治疗策略的选择 68323 TipInjection 150cmFineCross CTO介入治疗策略的选择 68323 Sion 150cmFineCross ToughSituation1 CTO介入治疗策略的选择 68323 Sion 150cmFineCross CTO介入治疗策略的选择 68323 GAIASecond 150cmFineCross CTO介入治疗策略的选择 68323 PositionofRetrogradeWire Frame CTO介入治疗策略的选择 68323 RetroWnotintoAnteGC eventhroughGuidezillaused ToughSituation2 Guidezilla CTO介入治疗策略的选择 68323 HomemadeSnarewith5Fchildcatheter 150cmFineCross RG3 BigloopofSion 5Fchildcatheter CTO介入治疗策略的选择 68323 HomemadeSnarewith5Fchildcatheter CTO介入治疗策略的选择 68323 Pre dilationandIVUS CTO介入治疗策略的选择 68323 a b a c d e b c d e Truetotruelumentracking CTO介入治疗策略的选择 68323 FinalResults CTO介入治疗策略的选择 大连医科大学2015 Case3 Male 55 2015 9 8failedtoattemptrecanalizationLAD CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 大连医科大学2015 FielderXT R GAIASecond Corsair CTO介入治疗策略的选择 大连医科大学2015 IpislateralCCtrackingwith150Corsair Sion CTO介入治疗策略的选择 大连医科大学2015 PingpangTechniqueandReverseCARTwith2 5mmballoon A GAIAFirst R GAIASecond CTO介入治疗策略的选择 大连医科大学2015 PingpangTechniqueandExternalizaitionwithRG3 CTO介入治疗策略的选择 大连医科大学2015 FinalResults CTO介入治疗策略的选择 56439 Case4 Male 48yrs 2015 3 10D1stented misrecognitionforLAD CTO介入治疗策略的选择 PrimaryRetro Nostump Stentstruts PromisingCC Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 56439 150Finecross Sion CTO介入治疗策略的选择 56439 150Finecross FielderXT CTO介入治疗策略的选择 56439 ModifiedReverseCART GAIASecond Sion CTO介入治疗策略的选择 56439 ModifiedReverseCART Sion SionnotintoAnteGC CTO介入治疗策略的选择 56439 Guidezilla CTO介入治疗策略的选择 56439 FinecrosschangedtoCorsair externalizationwithRG3 CTO介入治疗策略的选择 56439 FinalResults CTO介入治疗策略的选择 广西南宁2015 CASE5 Male 58yrs IDDM LVEF60 Firstattemptfailed CTO介入治疗策略的选择 广西南宁2015 CTO介入治疗策略的选择 广西南宁2015 R 6FSALL 7FEBU3 75 CTO介入治疗策略的选择 J CTOScore2 Stump length 20mm re trycase Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 广西南宁2015 130cmFineCross FielderXT R CTO介入治疗策略的选择 广西南宁2015 150cmFineCross Sion AVGrooveChannelinjured CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 广西南宁2015 ParallelWiringwithGAIAFirst CTO介入治疗策略的选择 J CTOScore3 WithoutStump length 20mm re trycase 广西南宁2015 SionintoRCA PL CTO介入治疗策略的选择 广西南宁2015 FinalResults CTO介入治疗策略的选择 广西南宁2015 CASE6 Male 55yrs OMI R AL0 75SHL 7FEBU3 5SH CTO介入治疗策略的选择 J CTOScore1 length 20mm Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 广西南宁2015 Balloonanchoring Parallelwiring FielderXT R GAIAFirst CTO介入治疗策略的选择 J CTOScore3 length 20mm calcification bending 45degrees Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 广西南宁2015 150Corsair Sion CTO介入治疗策略的选择 广西南宁2015 Knucklewiring FielderXT ConquestPro CTO介入治疗策略的选择 广西南宁2015 PreparingforReverseCARTwithGAIAFirst CTO介入治疗策略的选择 广西南宁2015 GAIAFirstintothetruelumen CTO介入治疗策略的选择 广西南宁2015 FinalResults CTO介入治疗策略的选择 61887 Case7 Male 60yrsold CTO介入治疗策略的选择 61887 7FEBU3 5SH6FSAL1 0SH CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Featuresfavouringearlyuseofdissection reentry AmbiguouscourseinCTOLength 20mmTortuousCTOsegmentHeavycalcificationLength 20mmPreviousfailedattempt Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm Successfulcrossing IFAntegradeapproachesFailed 61887 CrossBoss FielderXT Ultimatebros3 CTO介入治疗策略的选择 61887 Finalresults CTO介入治疗策略的选择 Carefulanalysisofcoronaryangiogram MSCT Considerstoppingif 3hr 3 7xeGFRmlcontrast AirKerma 5Gyunlessprocedurewelladvanced APCTOClubPCIAlgorithm IFAntegradeapproachesFailed Carefulanalysiso