ivus在lm介入治疗中的应用幻灯PPT课件

1、LM-PCI面临的特殊挑战面临的特殊挑战: CAGCAG提供的左主干病变程度、长度欠精确提供的左主干病变程度、长度欠精确 LMd-LADo-LCXoLMd-LADo-LCXo的斑块分布决定分叉病变干预策略的斑块分布决定分叉病变干预策略 位于位于“冠脉树冠脉树”根部的根部的LMLM生理特征变异大，纤维组织丰富，弹性强生理特征变异大，纤维组织丰富，弹性强 LMLM的的PCIPCI过程必须迅速精确、支架置入完美过程必须迅速精确、支架置入完美 血管内超声提供更多帮助血管内超声提供更多帮助第1页/共33页IVUS Guided LM-PCI nIVUS更清楚显示更清楚显示LM病变部位和程度病变部位和程度

2、nIVUS决定决定LMd病变治疗策略病变治疗策略nIVUS改善改善LMd病变治疗效果病变治疗效果第2页/共33页Prevalence of LMSS第3页/共33页IVUS : the most useful intracoronary diagnostic tool in the cath lab第4页/共33页IVUS-LADo-LMd Lesion distribution贾三庆，张宇晨，王雷，等贾三庆，张宇晨，王雷，等. .中华实用内科杂志，中华实用内科杂志，20022002，4 4（1414）7-9.7-9.第5页/共33页IVUS-LM Lesion LocalizationPat

3、ients (n=75)Only Ostial21%Only Mid Shaft13.1%Only Bifurcation65.5%From Costantino Costantini et al.第6页/共33页LM Bifurcation-IVUS ClassificationCAG 14.89% 4.27% 10.63% 29.78%IVUS 34.04% 6.38% 10.63% 25.53%CAG 8.51% 17.02% 14.89%IVUS 4.27% 12.76% 6.38%From Costantino Costantini et al.47 Bifurcations第7页/

4、共33页IVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of print第8页/共33页IVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of print第9页/共33页IVUS determinants of LM FFR0.75Jasti et al.Circulation 2004;110:28

5、31-6第10页/共33页IVUS Criteria for a Significant LMCA StenosislMost IVUS LMCA studies show either insignificant disease or critical diseaselAbsolute lumen CSA 6.0mm2 (or MLD 3.0mm) is the suggested criterion for a significant LMCA stenosis Correlates with a LMCA FFR0.75 Murrays Law (LMCAr3 = LADr3 + LCX

6、r3) Does not depend on finding a disease-free reference segment It is not clear whether the same criteria should be used for ostial LM lesions as for mid-shaft/distal bifurcation lesions and for positively vs negatively remodeled lesions-From Gary S Mintz-TCT2009第11页/共33页Conclusions:lIVUS guided ste

7、nting reduced long-term mortality rate compared with conventional angiography-guided stenting in DES placement for unprotected LMCA stenosislThe differential survival rate between IVUS-versus angiogrphy guidance start to separate and progressively diverged after 1 yearlTherefore,the reductioin of th

8、e risk of very late stent thrombosis by IVUS- guidance might play a role in improving survival after DES placement第12页/共33页Effect of IVUS upon Mortality of LM Stentingn=201 pairs (BMS+DES) 第13页/共33页Effect of IVUS upon Death or MI of LM Stenting n=201 pairs (BMS+DES) 第14页/共33页Effect of IVUS upon TVR

9、of LM Stenting n=201 pairs (BMS+DES) 第15页/共33页Effect of IVUS upon Mortality of LM Stentingn=145 pairs(DES)第16页/共33页对对LMLM进行血运重建的进行血运重建的IVUSIVUS标准标准: : 最小管腔面积6mm2 管腔面积狭窄率50% 最小腔径(MLD) 2.8mm第17页/共33页LMLM成功支架置入的成功支架置入的IVUSIVUS标准标准: : 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

10、腔面积0.9第18页/共33页LM-Case Presentation in Recent Work第19页/共33页CASE 01？57yrs Man UAP第20页/共33页Case 01第21页/共33页Case01第22页/共33页Case 01第23页/共33页Case 01-Final Result第24页/共33页Case0254yrs Man STEMI (Anterior Wall) Post infarction agina第25页/共33页Case02第26页/共33页Case02第27页/共33页Case02第28页/共33页Case 02第29页/共33页Case02-Final Result第30页/共33页ConlcusionslPre intervention IVUS is mandatory if technically possible 1.Important qualitative and quantitative information permit best approach. 2.Determine whet