（医学课件）“拘禁”球囊分支保护技术

1、Side Branch Protection: Jailed Balloon Technique“拘禁”球囊分支保护技术,1,Your Strategy?,Two-stent T stent V stent Crush cullote dedicated stent? Provisional stenting ? Cross over and final kissing? Too small vessel !,2,Provisional stenting,Stenting of the SB may be required in up to 51%. MB stenting can cause

2、 plaque shift, spasm, protrusion of the stent struts into the SB Changes in the bifurcation angle,The jailed balloon technique(JBT) is a novel modified provisional stenting technique that aims to maintain SB patency and improve SB access.,3,Jailed Balloon Technique,Both limbs of the bifurcation are

3、accessed with 0.014“ wire Predilatation of the MB with a standard semicompliant balloon,Step 1,Step 2,4,3. A monorail balloon that is sized to approximate the SB vessel diameter (generally 1.52.0 mm and of adequate length) The proximal marker of the SB balloon is positioned approximately (0- 2 mm) p

4、roximal to the stent,Step 3,Jailed Balloon Technique,5,4.The MB stent is deployed to nominal pressures, jailing the SB wire and balloon,Step 4,Jailed Balloon Technique,6,5. If the SB has not been compromised (i.e., TIMI 3 flow), then the trapped SB balloon is inflated to low pressure( 6 ATMs) If the

5、re is less than TIMI 3 flow in the SB, routine balloon angioplasty is performed before the balloon and wire are removed,Jailed Balloon Technique,Step 5,Keep stent balloon initial position!,7,6. The MB stent balloons position is maintained carefully during SB balloon removal,Jailed Balloon Technique,

6、Step 6,8,7. The stent balloon is then fully expanded to moderate or high pressure, optimization of MB stent apposition, and to correct any stent deformation as a result of the jailed-balloon inflation,Jailed Balloon Technique,Step 7,9,8. Final angiography will then reveal whether or not recrossing t

7、hrough the stent struts into the SB is necessary for provisional angioplasty and/or stenting.,Jailed Balloon Technique,Step 8,10,11,Long Term Outcome,12,Some Findings,The SB jailed balloon was removed in all patients without damage or entrapment of the balloon. JBT did not lead to any MB stent strut

8、 fractures Only one patient had stent deformation (IVUS) Reexpansion of the MB stent balloon after removing the jailed-balloon did not cause significant plaque shift.,13,Flow model finding,JBT,KB,14,The case,JBT 2.0*20,pre dalitation 2.0*20,stent 3.0*33,15,JBT 2.0*20,Stent 3.0*18,16,Take Home Message,JBT has high rate of procedural success and SB patency in dealing with bifurcation lesions It simplifies the procedure , save