CTO介入治療策略的選擇課件

CTO介入治療策略的選擇復旦大學附屬中山醫(yī)院心內(nèi)科上海市心血管病研究所葛雷CTO介入治療策略的選擇復旦大學附屬中山醫(yī)院心內(nèi)科上海市心DualCatheterAngiographyClearproximalcapGoodDistalTarget3.Length<20mmAntegradeRetrogradeyesnoWireescalationDissectionReentry(crossboss-stingray)WireescalationDissectionReentry(reverseCART)yesyesnonoBrilakisESetal.JACCCardiovascInterv2012TheHybridAlgorithmforCTOPCIinUSACTO介入治療策略的選擇僅僅評價了CTO正向的解剖結(jié)構(gòu)，對側(cè)枝血管的評估不夠正向技術(shù)和逆向技術(shù)的相互轉(zhuǎn)化條件不夠細化忽略了平行導引鋼絲技術(shù)忽略了IVUS在CTOPCI中的作用過分強調(diào)了ADR技術(shù)DualCatheterAngiographyClearCTO介入治療策略的選擇一百個觀眾心中就有一百個哈姆雷特，與之相似，不同的術(shù)者，就有不同的手術(shù)策略……,盡管手術(shù)策略多種多樣，但仍然有規(guī)律可循！CTO介入治療策略的選擇一百個觀眾心中就有一百個哈姆雷特，與Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235

Case1:Male,47yrsTinystump,healthydistalvessel,length<20mmCTO介入治療策略的選擇060235Case1:Male,47yrsTiCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235Corsair+FielderXTCTO介入治療策略的選擇060235Corsair+FielderXTCTO介060235GaiaFirstCTO介入治療策略的選擇060235GaiaFirstCTO介入治療策略的選擇060235StentingandFinalResultCTO介入治療策略的選擇060235StentingandFinalResul68323Case2:Male,69yrsCTO介入治療策略的選擇68323Case2:Male,69yrsCTO介入68323CTO介入治療策略的選擇68323CTO介入治療策略的選擇683237FEBU3.5CTO介入治療策略的選擇683237FEBU3.5CTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya68323KDL(Crusade)+SionCTO介入治療策略的選擇68323KDL(Crusade)+SionCTO介入68323IVUS(iLab)FrameCTO介入治療策略的選擇68323IVUS(iLab)FrameCTO介入治療策略68323FrameGAIASecond+130cmFineCrossCTO介入治療策略的選擇68323FrameGAIASecond+130cm68323CTO介入治療策略的選擇68323CTO介入治療策略的選擇68323TipInjection+150cmFineCrossCTO介入治療策略的選擇68323TipInjection+150cmFin68323Sion+150cmFineCrossToughSituation1CTO介入治療策略的選擇68323Sion+150cmFineCrossTou68323Sion+150cmFineCrossCTO介入治療策略的選擇68323Sion+150cmFineCrossCTO68323GAIASecond+150cmFineCrossCTO介入治療策略的選擇68323GAIASecond+150cmFineC68323PositionofRetrogradeWireFrameCTO介入治療策略的選擇68323PositionofRetrogradeWi68323RetroWnotintoAnteGC,eventhroughGuidezillausedToughSituation2GuidezillaCTO介入治療策略的選擇68323RetroWnotintoAnteGC,68323HomemadeSnarewith5Fchildcatheter150cmFineCrossRG3BigloopofSion5FchildcatheterCTO介入治療策略的選擇68323HomemadeSnarewith5Fc68323HomemadeSnarewith5FchildcatheterCTO介入治療策略的選擇68323HomemadeSnarewith5Fc68323Pre-dilationandIVUSCTO介入治療策略的選擇68323Pre-dilationandIVUSCTO介68323abacdebcdeTruetotruelumentrackingCTO介入治療策略的選擇68323abacdebcdeTruetotruelu68323FinalResultsCTO介入治療策略的選擇68323FinalResultsCTO介入治療策略的選擇大連醫(yī)科大學2015Case3:Male,55,2015-9-8failedtoattemptrecanalizationLADCTO介入治療策略的選擇大連醫(yī)科大學2015Case3:Male,55,20Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya大連醫(yī)科大學2015FielderXT-R,GAIASecond+CorsairCTO介入治療策略的選擇大連醫(yī)科大學2015FielderXT-R,GAIAS大連醫(yī)科大學2015IpislateralCCtrackingwith150Corsair+SionCTO介入治療策略的選擇大連醫(yī)科大學2015IpislateralCCtrack大連醫(yī)科大學2015PingpangTechniqueandReverseCARTwith2.5mmballoon(A:GAIAFirst;R:

GAIASecond)CTO介入治療策略的選擇大連醫(yī)科大學2015PingpangTechniquea大連醫(yī)科大學2015PingpangTechniqueandExternalizaitionwithRG3CTO介入治療策略的選擇大連醫(yī)科大學2015PingpangTechniquea大連醫(yī)科大學2015FinalResultsCTO介入治療策略的選擇大連醫(yī)科大學2015FinalResultsCTO介入治療56439Case

4:Male,48yrs,2015-3-10D1stented(misrecognitionforLAD)CTO介入治療策略的選擇PrimaryRetro:

Nostump,Stentstruts,PromisingCC56439Case4:Male,48yrs,201Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya56439150Finecross+SionCTO介入治療策略的選擇56439150Finecross+SionCTO介入56439150Finecross+FielderXTCTO介入治療策略的選擇56439150Finecross+FielderX56439ModifiedReverseCART+GAIASecond,SionCTO介入治療策略的選擇56439ModifiedReverseCART+G56439ModifiedReverseCART+Sion,SionnotintoAnteGCCTO介入治療策略的選擇56439ModifiedReverseCART+S56439GuidezillaCTO介入治療策略的選擇56439GuidezillaCTO介入治療策略的選擇56439FinecrosschangedtoCorsair,externalizationwithRG3CTO介入治療策略的選擇56439FinecrosschangedtoCors56439FinalResultsCTO介入治療策略的選擇56439FinalResultsCTO介入治療策略的選擇廣西南寧2015CASE5：Male,58yrs,IDDM,LVEF60%,FirstattemptfailedCTO介入治療策略的選擇廣西南寧2015CASE5：Male,58yrs,I廣西南寧2015CTO介入治療策略的選擇廣西南寧2015CTO介入治療策略的選擇廣西南寧2015R:6FSALL:7FEBU3.75CTO介入治療策略的選擇J-CTOScore2:Stump,length＜20mm,re-trycase廣西南寧2015R:6FSALCTO介入治療策略的選擇JCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015130cmFineCross+FielderXT-RCTO介入治療策略的選擇廣西南寧2015130cmFineCross+Fiel廣西南寧2015150cmFineCross+Sion,AVGrooveChannelinjuredCTO介入治療策略的選擇廣西南寧2015150cmFineCross+SionCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015ParallelWiringwithGAIAFirstCTO介入治療策略的選擇J-CTOScore3:WithoutStump,length＜20mm,re-trycase廣西南寧2015ParallelWiringwithG廣西南寧2015SionintoRCA-PLCTO介入治療策略的選擇廣西南寧2015SionintoRCA-PLCTO介入治廣西南寧2015FinalResultsCTO介入治療策略的選擇廣西南寧2015FinalResultsCTO介入治療策略廣西南寧2015CASE6：Male,55yrs,OMIR:AL0.75SHL:

7FEBU3.5SHCTO介入治療策略的選擇J-CTOScore1:length＞20mm廣西南寧2015CASE6：Male,55yrs,OCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015Balloonanchoring+Parallelwiring(FielderXT-R,GAIAFirst)CTO介入治療策略的選擇J-CTOScore3:length＞20mm,calcification,bending＞45degrees廣西南寧2015Balloonanchoring+PaCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015150Corsair+SionCTO介入治療策略的選擇廣西南寧2015150Corsair+SionCTO介廣西南寧2015Knucklewiring(FielderXT,ConquestPro)CTO介入治療策略的選擇廣西南寧2015Knucklewiring(Fielde廣西南寧2015PreparingforReverseCARTwithGAIAFirstCTO介入治療策略的選擇廣西南寧2015PreparingforReverse廣西南寧2015GAIAFirstintothetruelumenCTO介入治療策略的選擇廣西南寧2015GAIAFirstintothetr廣西南寧2015FinalResultsCTO介入治療策略的選擇廣西南寧2015FinalResultsCTO介入治療策略61887Case7.Male,60yrsoldCTO介入治療策略的選擇61887Case7.Male,60yrsoldC618877FEBU3.5SH6FSAL1.0SHCTO介入治療策略的選擇618877FEBU3.5SHCTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya61887CrossBoss,FielderXT,Ultimatebros3CTO介入治療策略的選擇61887CrossBoss,FielderXT,Ul61887FinalresultsCTO介入治療策略的選擇61887FinalresultsCTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvessel