左主干末端分叉病变支架术_陈绍良.ppt

左主干末端分叉病变支架术,南京市心血管病医院南京医科大学附属南京第一医院南京市第一医院陈绍良,一、最具影响力的询证医学研究,随访时间：1080天,23USSites,62EUSites,+,SYNTAXTrialDesign,*TAXUSExpress,SerruysPW,ESC2008,12MonthLMSubgroupMACCERates,AllLMN=705,LM+1VDN=138,LMisolatedN=91,Patients(%),12MonthLMSubgroupMACCERates,AllLMN=705,LM+1VDN=138,LMisolatedN=91,LM+2VDN=218,Patients(%),12MonthLMSubgroupMACCERates,AllLMN=705,LM+1VDN=138,LMisolatedN=91,LM+2VDN=218,LM+3VDN=258,Patients(%),12MonthSubgroupMACCERates,AllLMN=705,LM+1VDN=138,LMisolatedN=91,LM+2VDN=218,LM+3VDN=258,Patients(%),3VD(All)N=1095,SerruysPW,ESC2008,结论,危险分层,syntaxscore:23低危患者是PCI的有力适应对象AMIInoperablepatientslow-riskpatientsgroup:GoodLVfunction,isolatedLMorwithsingle-vesseldiseaseDESshouldbefirstchoiceforunprotectedleftmainstenting,影响左主干病变支架术的因素,三个血管段的直径分叉角度病变的分布DownstreamlesionsRCAlesionscharacteristics,二、左主干病变类型与介入技术,ChenSL，Cardiology，2009,真性分叉病变,ChenSL，Cardiology，2009,非分叉，但是影响术式的病变,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,Ostial,protrusion,Shaft,coverlength,Wholelength,distal?,Isolateddistal,cover?,ChenSL，Cardiology，2009,Cross-over,gap,Size,anglematched,Provisional,gap!,POTtech.,POTandpseudorestenosi,ChenSL，Cardiology，2009,POTandT,ChenSL，Cardiology，2009,FromDr.Murasado,Classicalcrushstenting,SKSstentingtechnique,Provisionalstenting,Stentdesigninimprovingstentingquality,Gapandrestenoticsitesafterclassicalcrush,DKcrushimproved.,GAP,RestenosisinBifur.SubgroupinDESEra,P=0.207*,P=0.032*,P=0.796*,P=0.003*,*ComparingCross-overwithcomplexstrategyGaoR,AmHeartJ2008:155:553,DISTALStudy,260pts非分叉164例（GroupA）真分叉96例（GroupB）,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,ChenSL，Cardiology，2009,