ivus在lm介入治療中的應(yīng)用幻燈PPT課件

1、LM-PCI面臨的特殊挑戰(zhàn)面臨的特殊挑戰(zhàn): CAGCAG提供的左主干病變程度、長度欠精確提供的左主干病變程度、長度欠精確 LMd-LADo-LCXoLMd-LADo-LCXo的斑塊分布決定分叉病變干預(yù)策略的斑塊分布決定分叉病變干預(yù)策略 位于位于“冠脈樹冠脈樹”根部的根部的LMLM生理特征變異大，纖維組織豐富，彈性強(qiáng)生理特征變異大，纖維組織豐富，彈性強(qiáng) LMLM的的PCIPCI過程必須迅速精確、支架置入完美過程必須迅速精確、支架置入完美 血管內(nèi)超聲提供更多幫助血管內(nèi)超聲提供更多幫助第1頁/共33頁IVUS Guided LM-PCI nIVUS更清楚顯示更清楚顯示LM病變部位和程度病變部位和程度

2、nIVUS決定決定LMd病變治療策略病變治療策略nIVUS改善改善LMd病變治療效果病變治療效果第2頁/共33頁P(yáng)revalence of LMSS第3頁/共33頁IVUS : the most useful intracoronary diagnostic tool in the cath lab第4頁/共33頁IVUS-LADo-LMd Lesion distribution賈三慶，張宇晨，王雷，等賈三慶，張宇晨，王雷，等. .中華實(shí)用內(nèi)科雜志，中華實(shí)用內(nèi)科雜志，20022002，4 4（1414）7-9.7-9.第5頁/共33頁IVUS-LM Lesion LocalizationPat

3、ients (n=75)Only Ostial21%Only Mid Shaft13.1%Only Bifurcation65.5%From Costantino Costantini et al.第6頁/共33頁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 Bifurcations第7頁/

4、共33頁IVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of print第8頁/共33頁IVUS-LM Plaque DistributionOviedo C, Maehara A, Mintz GS,et al.Circulation. 2010 Mar 2. Epub ahead of print第9頁/共33頁IVUS determinants of LM FFR0.75Jasti et al.Circulation 2004;110:28

5、31-6第10頁/共33頁IVUS Criteria for 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 + LCX

6、r3) Does not depend on finding 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-TCT2009第11頁/共33頁Conclusions:lIVUS guided ste

7、nting reduced long-term mortality rate 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 th

8、e risk of very late stent thrombosis by IVUS- guidance might play a role in improving survival after DES placement第12頁/共33頁Effect of IVUS upon Mortality of LM Stentingn=201 pairs (BMS+DES) 第13頁/共33頁Effect of IVUS upon Death or MI of LM Stenting n=201 pairs (BMS+DES) 第14頁/共33頁Effect of IVUS upon TVR

9、of LM Stenting n=201 pairs (BMS+DES) 第15頁/共33頁Effect of IVUS upon Mortality of LM Stentingn=145 pairs(DES)第16頁/共33頁對對LMLM進(jìn)行血運(yùn)重建的進(jìn)行血運(yùn)重建的IVUSIVUS標(biāo)準(zhǔn)標(biāo)準(zhǔn): : 最小管腔面積6mm2 管腔面積狹窄率50% 最小腔徑(MLD) 2.8mm第17頁/共33頁LMLM成功支架置入的成功支架置入的IVUSIVUS標(biāo)準(zhǔn)標(biāo)準(zhǔn): : 完全貼壁: 沿支架置入段支架完全帖靠血管壁 對稱均勻: 支架最大直徑比最小直徑0.7 擴(kuò)張充分: 支架最小腔面積(CSA)比平均參考血管

10、腔面積0.9第18頁/共33頁LM-Case Presentation in Recent Work第19頁/共33頁CASE 01？57yrs Man UAP第20頁/共33頁Case 01第21頁/共33頁Case01第22頁/共33頁Case 01第23頁/共33頁Case 01-Final Result第24頁/共33頁Case0254yrs Man STEMI (Anterior Wall) Post infarction agina第25頁/共33頁Case02第26頁/共33頁Case02第27頁/共33頁Case02第28頁/共33頁Case 02第29頁/共33頁Case02-Final Result第30頁/共33頁ConlcusionslPre intervention IVUS is mandatory if technically possible 1.Important qualitative and quantitative information permit best approach. 2.Determine whet