CTO介入治疗策略的选择-推荐课件

1、1,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,2,Dual Catheter Angiography,Clear proximal cap Good Distal Target,3. Length 20mm,Antegrade,Retrograde,yes,no,Wire escalation,Dissection Reentry (crossboss-stingray),Wire escalation,Dissection Reentry (reverse CART),yes,yes,no,no,Brilakis ES et al. JACC Car

2、diovasc Interv 2012,The Hybrid Algorithm for CTO PCI in USA,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CTO PCI中的作用 过分强调了ADR技术,3,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！,Careful analysis of coronary angiogram / MSCT,Consider stoppin

3、g if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,5,060235,Case 1: Male, 47 yrs,Tiny stump, healthy distal vessel, length 20mm,CTO介入治疗策略的选择,6,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Amb

4、iguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,7,060235,Corsair + Fielder XT,CTO介

5、入治疗策略的选择,8,060235,Gaia First,CTO介入治疗策略的选择,9,060235,Stenting and Final Result,CTO介入治疗策略的选择,10,68323,Case 2: Male, 69 yrs,CTO介入治疗策略的选择,11,68323,CTO介入治疗策略的选择,12,68323,7F EBU 3.5,CTO介入治疗策略的选择,13,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous c

6、ourse in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,14,68323,KDL (Crusade) + Sion,CTO介入治疗策略的选择

7、,15,68323,IVUS (iLab),Frame,CTO介入治疗策略的选择,16,68323,Frame,GAIA Second + 130cm FineCross,CTO介入治疗策略的选择,17,68323,CTO介入治疗策略的选择,18,68323,Tip Injection + 150cm FineCross,CTO介入治疗策略的选择,19,68323,Sion + 150cm FineCross,Tough Situation 1,CTO介入治疗策略的选择,20,68323,Sion + 150cm FineCross,CTO介入治疗策略的选择,21,68323,GAIA Sec

8、ond + 150cm FineCross,CTO介入治疗策略的选择,22,68323,Position of Retrograde Wire,Frame,CTO介入治疗策略的选择,23,68323,Retro W not into Ante GC, even through Guidezilla used,Tough Situation 2,Guidezilla,CTO介入治疗策略的选择,24,68323,Home made Snare with 5F child catheter,150cm FineCross,RG3,Big loop of Sion,5F child catheter,

9、CTO介入治疗策略的选择,25,68323,Home made Snare with 5F child catheter,CTO介入治疗策略的选择,26,68323,Pre-dilation and IVUS,CTO介入治疗策略的选择,27,68323,a,b,a,c,d,e,b,c,d,e,True to true lumen tracking,CTO介入治疗策略的选择,28,68323,Final Results,CTO介入治疗策略的选择,29,大连医科大学2015,Case 3: Male, 55, 2015-9-8 failed to attempt recanalization LA

10、D,CTO介入治疗策略的选择,30,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unle

11、ss procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,31,大连医科大学2015,Fielder XT-R, GAIA Second + Corsair,CTO介入治疗策略的选择,32,大连医科大学2015,Ipislateral CC tracking with 150 Corsair + Sion,CTO介入治疗策略的选择,33,大连医科大学2015,Pingpang Technique and Reverse CART with 2.5 mm balloon (A: GAI

12、A First; R: GAIA Second),CTO介入治疗策略的选择,34,大连医科大学2015,Pingpang Technique and Externalizaition with RG3,CTO介入治疗策略的选择,35,大连医科大学2015,Final Results,CTO介入治疗策略的选择,36,56439,Case 4: Male, 48 yrs, 2015-3-10 D1 stented (misrecognition for LAD),CTO介入治疗策略的选择,Primary Retro:No stump, Stent struts, Promising CC,37,C

13、areful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well a

14、dvanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,38,56439,150 Finecross + Sion,CTO介入治疗策略的选择,39,56439,150 Finecross + Fielder XT,CTO介入治疗策略的选择,40,56439,Modified Reverse CART + GAIA Second, Sion,CTO介入治疗策略的选择,41,56439,Modified Reverse CART + Sion, Sion not into Ante GC,CTO介入治疗策略的选择,42,5

15、6439,Guidezilla,CTO介入治疗策略的选择,43,56439,Finecross changed to Corsair, externalization with RG3,CTO介入治疗策略的选择,44,56439,Final Results,CTO介入治疗策略的选择,45,广西南宁2015,CASE 5：Male, 58 yrs, IDDM, LVEF 60%, First attempt failed,CTO介入治疗策略的选择,46,广西南宁2015,CTO介入治疗策略的选择,47,广西南宁2015,R: 6F SAL L: 7F EBU 3.75,CTO介入治疗策略的选择,

16、J-CTO Score 2: Stump, length20 mm, re-try case,48,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR

17、ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,49,广西南宁2015,130cm FineCross + Fielder XT-R,CTO介入治疗策略的选择,50,广西南宁2015,150cm FineCross + Sion, AV Groove Channel injured,CTO介入治疗策略的选择,51,Careful analysis of coronary angiogram / MSCT,Fea

18、tures favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade

19、approaches Failed,52,广西南宁2015,Parallel Wiring with GAIA First,CTO介入治疗策略的选择,J-CTO Score 3: Without Stump, length20 mm, re-try case,53,广西南宁2015,Sion into RCA-PL,CTO介入治疗策略的选择,54,广西南宁2015,Final Results,CTO介入治疗策略的选择,55,广西南宁2015,CASE 6：Male, 55 yrs, OMI,R: AL 0.75 SH L: 7F EBU 3.5 SH,CTO介入治疗策略的选择,J-CTO Sc

20、ore 1: length20 mm,56,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy

21、unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,57,广西南宁2015,Balloon anchoring + Parallel wiring (Fielder XT-R, GAIA First),CTO介入治疗策略的选择,J-CTO Score 3: length20 mm, calcification, bending 45 degrees,58,Careful analysis of coronary angiogram / MSCT,Features fav

22、ouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approache

23、s Failed,59,广西南宁2015,150 Corsair + Sion,CTO介入治疗策略的选择,60,广西南宁2015,Knuckle wiring (Fielder XT, Conquest Pro),CTO介入治疗策略的选择,61,广西南宁2015,Preparing for Reverse CART with GAIA First,CTO介入治疗策略的选择,62,广西南宁2015,GAIA First into the true lumen,CTO介入治疗策略的选择,63,广西南宁2015,Final Results,CTO介入治疗策略的选择,64,61887,Case 7.

24、Male, 60 yrs old,CTO介入治疗策略的选择,65,61887,7F EBU 3.5 SH 6F SAL 1.0 SH,CTO介入治疗策略的选择,66,Careful analysis of coronary angiogram / MSCT,Features favouring early use of dissection-reentry: Ambiguous course in CTO Length 20 mm Tortuous CTO segment Heavy calcification Length 20 mm Previous failed attempt,Cons

25、ider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,67,61887,CrossBoss, Fielder XT, Ultimatebros 3,CTO介入治疗策略的选择,68,61887,Final results,CTO介入治疗策略的选择,69,Careful analysis of coronary angiogram / MSCT,Consider stopping if 3 hr; 3.7x eGFR ml contrast; Air Kerma 5 Gy unless procedure well advanced.,AP CTO Club PCI Algorithm,IF Antegrade approaches Failed,70,Careful analysi