《ivus在lm介入治疗中的应用课件幻灯》由会员分享，可在线阅读，更多相关《ivus在lm介入治疗中的应用课件幻灯（33页珍藏版）》请在金锄头文库上搜索。
1、IVUS在在LM介入治疗中的应用介入治疗中的应用首都医科大学附属北京友谊医院首都医科大学附属北京友谊医院王王 雷雷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的斑块分布决定分叉病变干预策略预策略位于位于“冠脉树冠脉树”根部的根部的LMLM生理特征变异大，生理特征变异大，纤维组织丰富，弹性强纤维组织丰富，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IVUS
2、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Prevalence of LMSSIVUS : the most useful intracoronary diagnostic tool in the cath labIVUS-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.IVUS-LM Lesion Lo
3、calizationPatients (n=75)Only Ostial21%Only Mid Shaft13.1%Only Bifurcation65.5%From Costantino Costantini et al.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 Bifurcation
4、sIVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of printIVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of printIVUS determinants of LM FFR0.75Jasti et al.Circulation 2004;110:2831-6IVUS Criteria f
5、or 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 + LCXr3) Does not depend on findi
6、ng 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-TCT2009Conclusions:lIVUS guided stenting reduced long-term mortality rat
7、e 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 the risk of very late stent thrombosis
8、by IVUS- guidance might play a role in improving survival after DES placementEffect of IVUS upon Mortality of LM Stentingn=201 pairs (BMS+DES) Effect of IVUS upon Death or MI of LM Stenting n=201 pairs (BMS+DES) Effect of IVUS upon TVR of LM Stenting n=201 pairs (BMS+DES) Effect of IVUS upon Mortali
9、ty of LM Stentingn=145 pairs(DES)对LM进行血运重建的IVUS标准:最小管腔面积6mm2管腔面积狭窄率50%最小腔径(MLD) 2.8mmLM成功支架置入的IVUS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 腔面积0.9LM-Case Presentation in Recent WorkCASE 01？57yrs Man UAPCase 01Case01Case 01Case 01-Final ResultCase0254yrs Man STEMI (Anterio
10、r Wall) Post infarction aginaCase02Case02Case02Case 02Case02-Final ResultConlcusionslPre intervention IVUS is mandatory if technically possible 1.Important qualitative and quantitative information permit best approach. 2.Determine whether or not and how to do.lPost intervention IVUS is mandatory as possible as you can It decreases mortality!THANKS FOR YOUR ATTENDING
