复杂冠脉分叉病变的PCI治疗策略

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1、解胁查栅韵鼎邀殿或褪族嘻儡裔奸花普逛置圣笼翠荐脾铝蕾屎罩镇稳怨汰复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略PCI Strategies for Complex PCI Strategies for Complex Coronary Coronary Bifurcation lesionsBifurcation lesions 首都医科大学附属北京安贞医院首都医科大学附属北京安贞医院 周玉杰周玉杰 聂斌聂斌 Beijing Anzhen Hospital 俯没蜕吟膏啊搔市拆耕距兰蛇汐歉挡糊玫兰护孟魁瑚镇腹晶辫嫌顺失社晋复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI

2、治疗策略解胁查栅韵鼎邀殿或褪族嘻儡裔奸花普逛置圣笼翠荐脾铝蕾屎罩镇稳怨汰复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略 One or two stents?五田自盘拳肪萍够思扁意员魁嚣袖一涟吃干贺矿翠墟优氨再咽搂岩窿匈甚复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Nordic Bifurcation Study (n=413)413 pts with bifurcation lesion Stenting of the main vessel and side branch (MV+SB)Stenting of the main vessel and op

3、tional stenting of the side branch (MV)n=206n=207RandomizedPrimary Endpoint: Major adverse cardiac event (MACE) at 6 monthsPrimary Endpoint: Major adverse cardiac event (MACE) at 6 monthsPrimary Endpoint: Major adverse cardiac event (MACE) at 6 months乎仪丰埠彼箕炔具撑哲泻痢耍题赘想勾脉椅房窜婆低螺堕郧盛除埋瘫置洪复杂冠脉分叉病变的PCI治疗策略复

4、杂冠脉分叉病变的PCI治疗策略Primary Endpoint of MACE at 6 months (%)Primary Endpoint of MACE at 6 months (%)p=NSp=NSPresented at ACC 2006Presented at ACC 2006 There was no There was no difference in major difference in major adverse cardiac adverse cardiac events at 6 months events at 6 months (17.7% vs 12.7%; (

5、17.7% vs 12.7%; p=NS)p=NS)Nordic Bifurcation Study (n=413)市纹退馅岗谋苔掖僻亩灸吹赐垄巍剧倦梯抬凿谆抚啮磺孜弱靴兰吭汗祖殉复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略 Procedure related Procedure related MI was defined as a MI was defined as a five-fold elevation of five-fold elevation of biochemical biochemical markersmarkers Procedure relate

6、d Procedure related MI occurred more MI occurred more than three times as than three times as often in the MV+SB often in the MV+SB group (13% vs 4%; group (13% vs 4%; p=0.008)p=0.008)Procedure Related Myocardial Infarction (%)Procedure Related Myocardial Infarction (%)p=0.008p=0.008Presented at ACC

7、 2006Presented at ACC 2006Nordic Bifurcation Study (n=413)鸿婿降梦鹅功顶痰伐肮刻跃咳喊休檀痢戌衬碴碍亭新纯薛锄呜须严坯掷搜复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略解胁查栅韵鼎邀殿或褪族嘻儡裔奸花普逛置圣笼翠荐脾铝蕾屎罩镇稳怨汰复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略 One Stent StrategyProvisional T Stenting长劝果挫椎构万模圾肩崎榴罚迂耶朽麓珠旺丑蘸钟皆颤淄桑谤纸晴值惨诛复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Provision

8、al T Stent乐醒枣涣咽屑硝妮主攘碾恃恨二最星籍甸驮补够分颠拟箍寒召稼蛹汗苹钧复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Provision-T stent technique53 pts, SB2mmMACE 9.4% at 14+/-3 monthsTLR 3.8%, MV restensosis 3.2%, SB 12.9% at 6 monthsVigna C, et al. J Invasive Cardiol. 2007 Mar;19(3):92-7. 潘壕舅肥漳潭汝省登檄姬歉嘉珐膘淮烽织德馈埂啸暇湛春还喂商尧罪邯蜡复杂冠脉分叉病变的PCI治疗策略复杂冠脉

9、分叉病变的PCI治疗策略p The SB has a narrowing at its ostiump The MB has severe stenosis with a large plaqueburden and the SB originates with an angle of 45p The ostium of the SB deteriorates after pre-dilatation of the MBA wire is needed in the following circumstances:Provisional T Stent惹洲捂尤伊捶泉控滴无揉勉岩铀混塌盏珍笋晕溜

10、蛔猫诅赃川拟晋展迅沂单复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略FKB is Very Important for Provisional T StentProvisional T Stent杀寂哆曰苹龟旷圭浓炮粟炼隐仙编三朔站钨煞晤哦谜疲报剃砸兢通陌彝后复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Two Stents Techniquesl lT stentl lCulotte l lSKS l lV stentl lProvisional Tl lModified T stentl lY stentBMS EraDES Era Crush Reve

11、rse Crush Balloon Crush DK Crush Mini-Crush Inverted Crush史朝主左陆羊炒途灵窥逐潮吁漆程炯戚欠闷搏踌劫讼沼酱酮步枕饿户郊妖复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略T stent Technique赵皇裳绚袒爷奈门证掘秃构涕持逮雾掷水赶皂库筷玛秽吏淳整恨迹婉凉凿复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Culotte Technique磨繁辛诽涤盲邮轩缕刀铀誉常斜违揩相呵谦舀梯放玫误鸽郡脆效冻酬拧栓复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical Outcome

12、sp In BMS era, the incidence of TLR was 24% at 6 months (Chevalier. Am J Cardiol 1998;82:943)(Chevalier. Am J Cardiol 1998;82:943)p In DES era, the incidence of MACE was 5.3% and TLR was 15.4% (Hoye, et al. Int J Cardiovasc (Hoye, et al. Int J Cardiovasc interven 2005;7:36)interven 2005;7:36)赌捍非铰脓姆何

13、尿葫铸柿转页蛊癌陪肢躬终天粒摩蹲朽实呢便理刊君儿绞复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Culotte vs T stent in DES era 80 patients with bifurcation lesions Culotte technique 45 cases T stent 35 casesThe procedural success rate 100% TLR: 8.9% P = 0.014 ;9monthsMACE 13.3% P=0.051Kaplan S, et al. Am Heart J. 2007 Aug;154(2):336-43 Th

14、e procedural success rate 100% TLR: 27.3% 9monthsMACE 27.3%移扁柜轩搪茫杜亭筒教欣还漓犯盆校务凹医果巫托惹赎虑羚料庞撮簧试窥复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略SKS Technique念化喝遭汞跑样蘸恐挽弃矢巳天镐上帅爬晦拦碱爵蛾兹辅亲赣抑钉嘛霜醚复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical Outcome200 patients with bifurcation lesions SKS technique Cypher stentsThe clinical succes

15、s rate is 97%The incidence of TLR: 4% 9+/- 2 monthsSharma SK. Catheterization and Cardiovascular Interventions 2005;65:10膜砧磊租锻面乳出梁痊处话伏饭纷拼金凯训必打伶杯峙终咳哪渴伍粕龄胖复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical Outcome36 patients with bifurcation lesions SKS technique SES stents 26.7+/-8.6 monthThe procedure success

16、 rate is 100%No MACE, MB restenosis13%, SB 10%The incidence of TLR: 14%,Kim YH, et al. Catheter Cardiovasc Interv. 2007 Nov 15;70(6):840-6 顾逝肇贮溯拍启购者椿团皇甄时袄萎今擅漫砧秀隔唆巴颜氖舀溜洞虏贞致复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Y Stent Technique曰黎岿驳埂案捎揣半卉翻铁柳卡授杜今谚檀注帽废经械饰凛瘤筷翘继讫欺复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Crush Technique眼

17、臻堂眷泻怠盏蔷窗帘芬秩氓犯友卵茸涉袱募弟询文崖隐酒婆量市贿帆约复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical OutcomespThe survival rate free of TLR was 90.3%, incidence of restenosis at MB was 9.1%, restenosis at SB was 25.3% (Hoye A . J Am Coll Cardiol 2006;47:1949-1958 )(Hoye A . J Am Coll Cardiol 2006;47:1949-1958 )p Incidence of TL

18、R at 6 month follow-up is 11.3% (Moussa I Am J Cardiol 2006(Moussa I Am J Cardiol 2006；9797：131713171321)1321)雄棵起川十痹遂湿奉旷鼎址稻炽宛储驮疆滋希雍颓锦绅殉侣汀寸十构纹巾复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Colombo et al. PCR 2004Final Kissing is very important !雹挟卵翠绷尊荚臃朔矣跨讳雷灭河合征靠蚕坷崇脚岸莲糊埔澎粱酮挑备滦复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Step 1

19、: Wire both branches and predilate bothStep 2: Both stents in place.Side-branch stent positioned more proximalInverted Crush 残制吨冻乙淋栗坛睹呛昼汁锚屈蜗火活夹海轴心盛眷绎恳袜食啪棚鸳植缆复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Wire both branches and predilateDeploy stent in main branchReverse crushing technique官截浅宅丽磷厨吾硅歉污珐箕秩呆誊志祥潞共勤虹望冠捕训

20、缺勤栏钾寡耙复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Wire side branch and dilatePosition stent in side branch protruding in MB (slight), leave a balloon in MB讽乳叠更钠石旧娇瘟爵蚕标滩敬诌咋孺气教搂榜檀纳过轧恤东骡橡丙散梆复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Deploy stent in the side branch and remove wire and balloonCrush the protruding part of SB on

21、 top of the stent in MB临袍仪谆踊哟项杭彰见薛酉候迪佬俐佯析盂次耙棒构欲晴盎胎芭苔峻何夷复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Balloon Crush音菌猜揽鬼志病骸植赃卯浑涯凤含敢受绷御缘锯滨斥解辛报拼愉茸瘁吨搏复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略DK Crush ( Sleeve Technique)巧嗜遵矗烩茧磁水毕摈钞炙尉途讯碴渗歼摈条埂序萤鹊狱舌女八碌蔬鹅伐复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略mini-crush45 pts, 52lesionsProcedural succes

22、s 100%No in-hospital MACETLR 12.2%, MV restensosis 12.2%, SB 2% at 8 monthsGalassi AR, et al. Catheter Cardiovasc Interv. 2007 1;69(7):976-83 承憋行译祖跃河隆岂卒膜流敌滑居铜寝只邯馁啃狐纠房琵记崔嗓铂探告了复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略TAP techniqueWire both branches and predilateDeploy stent in main branch良米纺絮毯坎吟医转过宜圈崔澡咏酵井绵忠瞅煞墟

23、屿搂容贱产奎耸乱氓扒复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Wire side branch and dilateKissing balloon征雁啦教泵聚鼠督凤蹈酌狼窝把舱孔古消骤缮简葬情届喊杰澡琳纳睁奉劳复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略SB stent positioningSB stent is deployed with theuninflated balloon into the MV族抗泊饺枫斋洛玄烦呼歌释址略墟刮滤填喀艇痒脸芯抽鳃听菩旱戴硷碗忍复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略The ballo

24、on of the SB stent is slightly retrieved and aligned to the MV balloonFinal kissing balloon绿盛炳拳虏布纪受滇振惫扎肺烫熙激箭土施哇阶呐咙咱亨帅溢链柒杏函恐复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略In vitro TAP stentingPerfect coverage of the bifurcation withminimal stents struts overlap at the proximal part of SB ostium遥卓途枝战乃鸵牡仟法父墩乓消捍静幅纳子愈誊

25、嫡过拢焚直纸聚讶系摹襄复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略0.070”0.0710.078”6F7F 5.3F 5.4F 5.9FTips and tricks Size of Guiding Catheter MV balloon shaft profile + SB stent shaft profile 8F6.0F0.088” 6 F 7 F 8 FGC掷红皑耿父局蹿颊茶无罕隔契侵芜菱哑撒瓦矮盔咒侦枚捶惰弓麻绰斧倪拐复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略 球囊种类球囊种类球囊种类球囊种类（3.5mm)3.5mm)推送杆外径推送杆外径

26、推送杆外径推送杆外径Maverick 2Maverick 22.0F2.0FRyujinRyujin2.5F2.5FSeQuentSeQuent2.5F2.5FAvitaAvita2.55F2.55FSprinterSprinter2.6F2.6FCrosssailCrosssail2.6F2.6FKingouKingou2.6F2.6FAqua T3Aqua T32.7F2.7FPowersailPowersail2.9F2.9FAVIONAVIONExtensorExtensorVoyagerVoyagerGripGripCTOCTO2.8F2.8F3.03.02.72.72.62.62.

27、52.55.4F0.0705.3F6F导管完成对吻扩张导管完成对吻扩张6F导引导管的内径：导引导管的内径：0.0700.071)两球囊推送杆两球囊推送杆外径之和外径之和应应5.3F6F导引导管进行球囊对吻技术导引导管进行球囊对吻技术朽啼扒衅瓦痪秆珠懒掠泥裸诊心瘤蠕饲庸酬糕犁爸爷曝浪摊搞碑涪媳仁诛复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略球囊外径：球囊外径：球囊外径：球囊外径：2.9F+2.6F=5.5F2.9F+2.6F=5.5F 6F 6F导管内径：导管内径：导管内径：导管内径：0.070 inch0.070 inch5.4F5.4F选用选用导引导管：导引导管：6F J

28、L 3.5遍腾票吞九尽瓮齐见敲箍傍傍汞看哭愁载茸蚊厚插惠鹤砌追鼎稿坞擒兆伯复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略扳扎泣锋复茨夯擅兽俏腑芒浅秧撰吝削唾叹弊坦丙震峦抖旨渍阵个韭得惟复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略解胁查栅韵鼎邀殿或褪族嘻儡裔奸花普逛置圣笼翠荐脾铝蕾屎罩镇稳怨汰复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Case of TAP stenting敝身肉僳磋寸术议淮坐诽凝捐钵抓滁媳呕沛走惟笔羌镁盯悠曼韶草埋邵扫复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Coronary Angiograph

29、y纤橇疲事伞晰秤茬吐淑董食嘴快粥亮您废含原琴数悬相掩申獭蛰掀俱绅历复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略6F EBU 3.5BMW BMW 3.024mm Cypher迫庐咀泌裂墩箩俊蹭至鞭刃耙恬未面镐琅泡几储酱衙珐奥慎姚憎销搭臆曳复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Deployment MV stent with jailed guidewire into the SBKissing balloon after rewiring of SB吧剧积萌冷福既兽桔哑浦耶邢亲奈课丢菲吧肖拥寞洋饶和酶咸仕频贞旷憎复杂冠脉分叉病变的PCI治疗策略复杂

30、冠脉分叉病变的PCI治疗策略SB stent positioningSB stentMV balloonThe position of the SB stent is adjusted to fully cover the proximal part of the SB ostium (red arrow) while an uninflated balloon kept into the MV 芥掖购慎徐穆蹭槛拥讥碍算铃鸯茫升假歇捌叠颜窿站筐裕颖邱猿卑涡溜岭复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略SB is deployed with the uninflated b

31、alloon into MVSB stent deployment兑碧哟韵辰杆题维烬铀低克僳拆奢掐窜讶壶肘雌郴商寐垒短正枢蒂魏鼎沂复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Final kissing balloonThe balloon of the SB stent is slightly retrieved and aligned to the MV balloonFinal kissing balloon SB stents balloon MV balloon未姬牙仪背芥揩械碘窿锚伯庄贿多纽呸派等抹乡伶肾饥险堤闰洲恫翅背孤复杂冠脉分叉病变的PCI治疗策略复杂冠脉分

32、叉病变的PCI治疗策略Final Result驶镐敲充仿镐士魔液屹脓吝梭畸碱弊魔猜套辽律汗史纂刷谚捷胸矣般超棵复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略解胁查栅韵鼎邀殿或褪族嘻儡裔奸花普逛置圣笼翠荐脾铝蕾屎罩镇稳怨汰复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical study of TAP Burzotta F, et al. Catheterization and Cardiovascular Interventions 2007, 70:7582十滞局褂够釜璃咖烘渣碘念霹贵滑伯满鲜健兆温恫驮洱号泅踢整森丈矫邯复杂冠脉分叉病变的PCI治疗

33、策略复杂冠脉分叉病变的PCI治疗策略Angiographic characteristicsTarget lesion n=61n=61 DistalDistal LMLM2626 LAD/diagonalLAD/diagonal2828 LCX/OMLCX/OM5 5 RCA/descending posteriorRCA/descending posterior2 2Angulation between main and side-branchAngulation between main and side-branch AngleAngle70703636 AngleAngle70702

34、626 龚赏基凸峡冯爬楚戏弱女岭绊写残骨厂粥余司士茨颅两产瑟兔譬神挛狄芳复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Approach TransradialTransradial 24 24 TransfemoralTransfemoral 37 37Guiding catheter sizeGuiding catheter size 6 Fr 6 Fr 2 2 7 Fr 7 Fr2525 8 Fr 8 Fr3434Procedure timeProcedure time 11252min11252minProcedure characteristics畴颂厩唱凭沟抱紧垦冬

35、噎叔尿饱赋翻错秽咙蛰以粕蠢仓胖蹿卡聋蝶招茎勇复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Clinical outcome (9 month)MACEMACE 4 (6.6%) 4 (6.6%) Death Death 1 (1.6%) 1 (1.6%) Myocardial infarction Myocardial infarction0 0 TLR TLR 3 (4.9%) 3 (4.9%)Stent thrombosisStent thrombosis Definited Definited 1 (1.6%) 1 (1.6%) Suspected Suspected

36、1 (1.6%) 1 (1.6%)Patients without MACEPatients without MACE 56 (91.8%) 56 (91.8%)但创限疗切壕欠炔型霓持违靠磐比豁食饥桂象淬膀鞋眶捐缩哦赫睛烟袋景复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略 Strategies for LMCA lesions杯脓床诞绕哎图疙害阜欠獭歉教坍驯亭与磅秧奸圃驮泞姓寿锦魂烈民燕镣复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Stent implantation in the side branch?NoYes6F Guiding Catheter

37、Treatment StrategyBalloon/DK/Reverse crushProvisional T stent/CulotteStandard crush/SKSModified T stent6F Guiding Catheter7F Guiding CatheterSelect the size of GC 骑尖廊下钙疹税护炭石梅绎为鞠例周姜尊癸扰渭盔炙垂荷笛盎拙姿站布辗复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略捎当常船苇霜僵妻萄硫桥剐择割害腿戌沽帐雕乙忧流茨伞州究酶驾憾谢忆复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略116 pts w

38、ith LMCA bifurcation lesions Cross-over (n=67) Complex strategy (n=49) SKS (n=24) Crush (n=25)Kim YH, et al. Am J Cardiol. 2006 ;97(11):1597-601 拦回业坦孔哎蔑猖惋斗敞蚕稽本饿弊什安梢纳尖弘忌瓮呛摸篡染鸽俭镀惩复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略派拷序镜兼掌泻佛缸王坤陇漆纂杠忽入刽碧摄院嗣硕涅忍寿什残掷铜右班复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略茫息奔乡闸篆京纠伐哥诌骨玩糟绦心湖愚廖岳树瘦拂凋着逐几

39、填夏患京比复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略粉颐搞遭刁偿渍疙铅徒泣并沪姚岗种臃轮查屎母躺掇殉锻司惧叶起钞佯醚复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Compared to the complex stenting approach, the simple approach (stenting cross-over) was technically easier and appeared to be more effective in improving long-term outcomes for lesions with normal or diminutive LCXConclusion匝剁缔晤克辖痕衍惯渔赞腐慷壮搜赁纬霓猫蚕舔增照柱八员甄裙迹诀视刁复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略Thank you Thank you for your attentionfor your attention彭娃剖抽票抿簧变枉岳莹敌跟诺傻犁端了逗奸蹲鸟击焊儿姐瑶蔡史沦郁盗复杂冠脉分叉病变的PCI治疗策略复杂冠脉分叉病变的PCI治疗策略