冠脉旋磨术适应证选择课件

1、冠脉旋磨术适应证的选择冠脉旋磨术适应证的选择Rotational AtherectomyDeveloped early 1980s, David Auth PhDduring new device eraUnique operating principle differentialcutting of inelastic (calcified/fibrotic) tissueFall from favour/use late 1990s 1. unfavourable restenosis data (ERBAC,ARTIST)2. regarded as time-consuming to

2、useRotational Atherectomy冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？如何选择适应证？冠脉旋磨术中需要注意的几个问题冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件During past few years, scope of PCI has advanced g

3、reatly, including several subsets:Complex, calcified lesionsVery elderly patients (10% JGM PCI pts 80yrs)Patients with extensive comorbidity (CRF etc) turned down for CABG that provide resurgent role for Rotablator in improving procedural outcome.In 2019, 55 RA of 462 total PCIs (11.9%)Is there cont

4、emporary evidence to support this practice?时代不同了During past few years, scope oRandomisation Of Calcified Coronary Stenoses toTAxus stenting with or without Rotational atherectomy132 patients at least one moderate-severely calcified lesion on fluoroscopyRotablation/DES vs DES alonePrimary endpoint 8

5、month binary angiographic restenosisSecondary endpoints procedural success/MACE; acute/subacute/late stent thrombosisROCCSTAR TrialRandomisation Of Calcified CorROCCSTAR recruitment to date 113 patients57 Roto/DES56 DES alone34 large 23 small34 large22 small(3mm or )92% angiographic follow upROCCSTA

6、R recruitment to dateIn arriving at 56 pts in DES alone limb, of 64 pts intended for this limb, 8 (12.5%) unable to predilate fully (placed in ROCCSTAR Rotablator registry)Subacute stent thrombosis 2/56 (3.6%) in DES alone limb (both in small vessels) vs 0/57 in Roto/DES limbROCCSTAR 2 observations

7、to date reimpact of Rotablation on procedural outcome in calcified lesionsIn arriving at 56 pts in DES a冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？如何选择适应证？冠脉旋磨术中需要注意的几个问题冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？Improve procedural outcomeExpand indications of PCIBalloon undilatable or uncrossable lesions, especially with superficial calc

8、ificationOstial lesions, particularly aorto-ostial stenosisBifurcation lesionsLong lesions 25 mmContraindicationsThrombus-contFDA的建议FDA的建议冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？如何选择适应证？冠脉旋磨术中需要注意的几个问题冠脉旋磨术适应证的选择为什么要选择冠脉旋磨术？冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件指引导管 / 磨头兼容性* an .004” clearance is recommended指引导管 / 磨头兼

9、容性* an .004” clearan冠脉旋磨术适应证选择课件支架扩张术旋磨支架术支架扩张术旋磨支架术冠脉旋磨术适应证选择课件冠脉旋磨术适应证选择课件Case 160 yrs, MSmokingfamily historyHypertensionDMnon-Q AMI history mild effort dyspneaSPECT: antero-septal & lateral perfusion defectsCase 160 yrs, MDM围手术期抗栓ASA：100 mg/day Clopidogrel： 300mg 6 hrs beforeUFH：7000 I.U. during

10、 procedureEptifibatide: Double bolus followed by infusion during procedure围手术期抗栓ASA：100 mg/day 7Fr EBU 3.5PT GW in D1BMW in distal LAD.After predilation, 2520 & 22508 Taxus stents in proximal-middle D1with a residual stenosis at the ostium. 7Fr EBU 3.5Unsuccessful predilation in calcified LADRotatio

11、nal atherectomy (1.75mm burr) 2.7532 & 3.012 overlapping Taxus stents involving D1 ostium Unsuccessful predilation in caRecross D1 with Pilot 150, but failed in any balloon positioning“Push back ” balloon technique: 3020 balloon placement in LAD & 1515mm balloon placement D1, inflating the bigger ba

12、lloon pushing at the same time the smaller ballooninto the side branch using the bigger balloon as supportstep-up predilation & placed a 2512mmTaxus stent at ostium of the sidebranch with a”Vstenting technique Recross D1 with Pilot 150, butGood final resultClopidogrel 75mg was continued for 12 months.No intra or peri- procedural complicationsA low rise of enzyme level