CTO Case:Retrograde approach.ppt
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1、CTO Case: Retrograde approach,哈尔滨医科大学附属第四医院心脏中心,4th Hosp. Harbin Medical University,EACS 2007,病历摘要,患者:李XX 女 67岁 主诉:间断胸闷十年,发作性胸痛一年 体格检查:S1减弱 辅助检查: ECG:SR,ST-T 改变 UCG:室壁运动不协调,前壁及前间隔运动减弱 LA 31mm LV 41mm IVS 14mm LVPW 13mm EF 78% E/A 1,4th Hosp. Harbin Medical University,EACS 2007,临床诊断,临床诊断: 冠心病 不稳定型心绞痛
2、 高血压 高脂血症 危险因素: 高血压 (BP 150/80 mmHg) 高脂血症 (LDL 3.14 mmol/L),4th Hosp. Harbin Medical University,EACS 2007,LCA - CAG,LAD - CTO,LCX - 80%,D1 - 50%,4th Hosp. Harbin Medical University,EACS 2007,RCA - CAG,RCA 80% stenosis,primary dissection,4th Hosp. Harbin Medical University,EACS 2007,手术策略选择,4th Hosp.
3、Harbin Medical University,EACS 2007,器械选择,选择GC:,4th Hosp. Harbin Medical University,EACS 2007,器械选择,选择GW:,4th Hosp. Harbin Medical University,EACS 2007,PCI: antegrade approach,TRI antegrade approach failure(GW: PILOT 150 / Cross IT 300),4th Hosp. Harbin Medical University,EACS 2007,下一步怎么办?,术者意见 A、放弃,行
4、CABG? B、部分血运重建? C、下次再尝试或应用其他技术? 专家意见 ?,4th Hosp. Harbin Medical University,EACS 2007,History of retrograde approach to CTO,Late 80s: retrograde approach to grafted conventional stenosis - Dr Hartzler Early 90s: retrograde approach to CTO via vein graft and collateral channel Late 90s: kissing wire t
5、echnique-bilateral approach Early 00s: making crack with retrograde balloon to facilitate antegrade wire crossing 2005: controlled antegrade and retrograde subintimal tracking (CART); septal channel dilation technique,4th Hosp. Harbin Medical University,EACS 2007,Retrograde approach器械选择,如何选择RCA-GC?,
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