慢性完全性闭塞病变的病情介绍:重要概念和技术-英文.ppt
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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 angioplaty Improve the prognosis?,Recent concepts and techniques Can we treat a patient smartly?,CTO angioplasty,Role of DES fo
2、r 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 PM
3、S in Japan),Background Post market evaluation to fulfill a Regulatory Approval Condition Purpose To evaluate the safety and efficacy of the Cypher Sirolimus-eluting coronary stent in routine daily practice in the Japanese population Target Enrollment 2,000 patients (1st year=1,000 patients, 2nd year
4、 =1,000patients) No of Sites 50 sites (Select sites on basis of balanced population density, hospitals distribution as well as scale of hospitals) Method Prospective Non-randomized Registry Inclusion Criteria Consecutive patients treated with the Cypher stent(including off abel use) Follow-up In-Hos
5、pital,3,8 months and 1,2,3,4,5 years clinical follow-up data :Angiographic follow-up is mandated at 8 months(Analysis:Core lab),Enrollment Period 1st Year: 9/1/043/31/05 2nd 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
6、,1,857 cases,Follow 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 Mon
7、ths Follow-up,Values are n (%). *:Based on ARC Definition *:Excluding 1 case with procedure failure (MI occurred during PCI procedure),SES for CTO lesions: BMS vs SES Himeji CVC Experience,CTO angioplasty:BMS vs SES,Clinical follow-up: 12Mo Consecutive 181 patients with 185 lesions,BMS group,SES gro
8、up,SES available(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,(
9、Himeji CVC),Recent concepts and techniques for CTO angioplasty,65 y.o M EAP DM, HT Retry 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,C
10、ontrol angiography,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
11、 at LAD,T.H 65 y.o M 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 vi
12、ew,Guidewire handling: Parallel guidewire technique Retrograde approach (selected case) IVUS-guided (if possible),Visualization of coronary vessels before PCI MDCT,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
13、 M EAP,Pre PCI,Pre PCI,Post 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
14、 reading on the electronic 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),(
15、),First Wire,Second Wire,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 s
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- 慢性 完全性 闭塞 病变 病情 介绍 重要 概念 技术 英文
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