冠脉精品课件：为何要从远端网眼下导丝进入分支10-7.pptx

1、为何要从远端网眼下导丝进入分支 Why Rewire SB from Distal Cell of Main Vessel Stent,浙江大学医学院附属邵逸夫医院心血管内科 周斌全 Cardiology Department, Sir Run Run Shaw Hospital Binquan Zhou，MD, FACC, FSCAI,Bifurcation Stenting,Bifurcation angioplasty accounts for 15% - 20% of total PCI PCIs in these circumstances challenging Technical

2、ly difficult and time consuming Higher resource utilization and cost Lower procedural and angiographic success rates Inferior long term clinical outcomes Provisional side branch stenting should be the default approach,Why Provisional Stent strategy ?,Frequent situation Simple treatment Similar resul

3、ts to 2-stent strategy Easy conversion to 2-stent treatment if needed ( TAP, Culotte ) The best indications,One stent when we can Optimal strategy for high success and low need for SB stenting,Start with 2 wires Select the MB stent diameter according to the distal reference Liberal use of the POT te

4、chnique When SB needs attention: FKB or POT/Side/POT Use NC balloons T stenting for residual significant SB or dissection,Rewiring,When SB needs attention,When SB needs attention,The available clinical data suggest that routine kissing balloon ination is not associated with improved clinical outcome

5、 Kissing ballooning in patients undergoing provisional stenting has been recognised to acutely improve the SB fractional ow reserve in case of suboptimal result after MV stenting improve the acute and long-term angiographic result at the level of SB ostium be associated with reduced post-procedural

6、inducible ischemia,1,2,3,Where should we rewire,MV Stent Distortion after FKBD,Recross distally Proximal recrossing causes a large neocarina Distal recrossing scaffolds the proximal aspect of the side-branch ostium,Burzotta et al. EuroIntervention 2015;11:V91-V95,Wire should cross the MV into the SB

7、 through the distal cell,N. Foin et al. International Journal of Cardiology 168 (2013) 36233628,Wire should cross the MV into the SB through the distal cell,N. Foin et al. International Journal of Cardiology 168 (2013) 36233628,Wire should cross the MV into the SB through the distal cell,N. Foin et

8、al. International Journal of Cardiology 168 (2013) 36233628.,Wire should cross the MV into the SB through the distal cell,N. Foin et al. International Journal of Cardiology 168 (2013) 36233628.,Wire should cross the MV into the SB through the distal cell,21,Recrossing wire through distal cell.,Recro

9、ssing wire through proximal cell.,OFDI image from Internal bench test.,22,Recrossing wire through distal cell.,Recrossing wire through proximal cell.,OFDI image from Internal bench test.,Abbreviation MV: Main Vessel SB: Side Branch GW: Guidewire L: Link between cell,3D-OFDI with Stent enhancement en

10、able us to verify recrossing wire position.,L,L,OFDI image from Internal bench test.,Courtesy of Terumo,Serial changes in the SBOA,3D-OCT,Representative image,Tatsuhiro Fujimura, et al. European Heart Journal - Cardiovascular Imaging (2017) 0, 19,Take home message,Provisional side branch stenting should be the default approach SB rewiring site impacts on MV stent distortion after SB dilation. Crossing of the MV stent struts in the most distal cell is associated with better SB ostium scaffolding 3D-OCT enable us to verify recrossing wire position,Thanks,