《慢性完全性闭塞病变的病情介绍重要概念和技术英文》由会员分享，可在线阅读，更多相关《慢性完全性闭塞病变的病情介绍重要概念和技术英文（49页珍藏版）》请在金锄头文库上搜索。
1、Chronic Total Occlusion(CTO) Case Presentation: Key Concepts and Techniques,Takatoshi Hayashi MD Himeji Cardiovascular Center, Japan,2008.4.12 Guangzhou,Role of DES for CTO angioplatyImprove the prognosis?,Recent concepts and techniquesCan we treat a patient smartly?,CTO angioplasty,Role of DES for
2、CTO angioplaty,CTO angioplasty in DES era,BMS,DES(SES),SICCO,GISSOC,STOP,TOSCA,Nakamura,Hoye,0,60,50,40,10,30,20,(%),Re-occlusion,Restenosis,24%,47%,34%,32%,8%,8%,8%,3%,6%,Nakamura,2%,Ge,3%,9%,9%,SES for CTO lesions:CTO vs Non-CTO Cypher Post Marketing Study (PMS) in Japan,Study Design (Cypher PMS i
3、n Japan),Background Post market evaluation to fulfill a Regulatory Approval Condition PurposeTo evaluate the safety and efficacy of the Cypher Sirolimus-eluting coronary stent in routine daily practice in the Japanese populationTarget Enrollment 2,000 patients (1st year=1,000 patients, 2nd year =1,0
4、00patients)No of Sites50 sites (Select sites on basis of balanced population density, hospitals distribution as well as scale of hospitals)MethodProspective Non-randomized RegistryInclusion CriteriaConsecutive patients treated with the Cypher stent(including off abel use)Follow-up In-Hospital,3,8 mo
5、nths and 1,2,3,4,5 years clinical follow-up data ：Angiographic follow-up is mandated at 8 months（Analysis:Core lab),Enrollment Period1st Year: 9/1/043/31/052nd Year: 4/1/059/30/05,Intent-to-treat,Actual Enrollment,8M Angiographic F/U,12M Clinical F/U,2,054 cases,2,051 cases,1,752 cases,1,857 cases,F
6、ollow up Rate：85.4 90.5,Delivery Success Rate: 99.8%,Study Profile of Cypher PMS in Japan,Lesion Characteristics,(mm),0.31mm,0.22mm,P=0.132,(%),11.2%,8.9%,P=0.453,(%),3.9%,3.9%,P=0.806,Efficacy Evaluation,TLR (12 Months),Late Loss (8 Months),Binary Restenosis (8 Months),MACE to 12 Months Follow-up,V
7、alues are n (%). *:Based on ARC Definition *:Excluding 1 case with procedure failure （MI occurred during PCI procedure）,SES for CTO lesions: BMS vs SESHimeji CVC Experience,CTO angioplasty:BMS vs SES,Clinical follow-up: 12Mo Consecutive 181 patients with 185 lesions,BMS group,SES group,SES available
8、(2004.8-),(Himeji CVC),CTO angioplasty: BMS vs SES Angiographic results (6Mo-),9.3%,BMS (n=74) (Angio F/U 72%),37.8%,* :P0.001,28.5%,(Himeji CVC),Clinical events during follow-up period,(Himeji CVC),Major adverse cardiac events (MACE),MACE free survival : CTO angioplasty BMS vs SES,(Himeji CVC),Rece
9、nt concepts and techniques for CTO angioplasty,65 y.o M EAPDM, HTRetry Case (unsuccessful； 3 month before),Case,A PCI Case of LAD-CTO, treated in a certain country in East-South Asia with arguing with a doctor in charge.,Control angiography,AP-Cranial,RAO,T.H 65 y.o M EAP LAD-CTO,Control angiography
10、,Spider view,T.H 65 y.o M EAP LAD-CTO,Strategy:Retrograde or antegrade approach ?,Retry case: Inadequate vessel selection in the first PCI try(Guidewire in high lateral branch) Collateral pathway : very tortuous at distal,How do we treat this case?,T.H 65 y.o M EAP LAD-CTO,Wiring at LAD,T.H 65 y.o M
11、 EAP LAD-CTO,Re-wiring and dilation with a 2.5mm balloon by the physician,T.H 65 y.o M EAP LAD-CTO,Change the Operator,T.H 65 y.o M EAP LAD-CTO,Re-wiring,Parallel wire technique,Guidewire: Conquest, Fielder,T.H 65 y.o M EAP LAD-CTO,Recent advance in CTO angioplasty:Procedural view,Guidewire handling
12、:Parallel guidewire techniqueRetrograde approach (selected case) IVUS-guided (if possible),Visualization of coronary vessels before PCIMDCT,Anchor balloon technique:Back-up force,Guidewires for CTO lesion,K.S 64 y.o M EAP,RCA,LAD,Cx,LAD,Cx,MDCT(64): Coronary artery,K.S 64 y.o M EAP,Pre PCI,Pre PCI,P
13、ost PCI (SES implanted),K.S 64 y.o M EAP,The stiffness of a guide wire :expressed as the resistance of the tip to bending (1cm from tip) against force (g),(measured by Asahi Intecc.Co),A guide wire is inserted in a tube and its tip is advanced toward an electronic scale.,The reading on the electroni
14、c scale increases when the guide wire is pressed against the sale.,The reading increases more when the guide wire is advanced further.,The reading decreases When the guide wire is advanced much further,(0.3g),(0.5g),(0.7g),(0.0g),10mm,Comparison of Tip Stiffness(Guidewire),（）,First Wire,Second Wire,
15、Parallel Guidewire Technique,modified; Tamai, 2007,LAD: Cranial view,LAD: RAO view,First Wire,Second Wire,Second Wire: position A,Second Wire: position B,Second Wire: position B,Second Wire: position A,Distal fibrous cap,First Wire,Second Wire,Sub-intimal space,Sub-intimal space,Parallel Guidewire T
16、echnique,modified; Tsuchikane et al, 2007,Second wire: stiff, tapered wire,Septal Br.,Diagnal Br.,Septal Br.,Diagnal Br.,Parallel guidewire technique:Advantage,O.T 64 y.o EAP,Control angiography: Cx CTO,O.T 64 y.o EAP,PCI: Cx CTO,O.T 64 y.o EAP,IVUS after first wiring,O.T 64 y.o EAP,IVUS guided wiring,Guidewire: Conquest pro,IVUS cathether,O.T 64 y.o EAP,After re-wiring,
