CTO介入治疗策略的选择参考
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7
060235
CTO介入治疗策略的选择
Gaia First
8
060235
CTO介入治疗策略的选择
Stenting and Final Result
9
060235
CTO介入治疗策略的选择
Case 2: Male, 69 yrs
10
68323
CTO介入治疗策略的选择
11
68323
CTO介入治疗策略的选择
CTO介入治疗策略的选择
Case 1: Male, 47 yrs
Tiny stump, healthy distal vessel, length <20mm
5
060235
AP CTO Club PCI Algorithm
Careful analysis of coronary angiogram / MSCT
7F EBU 3.5
12
68323
AP CTO Club PCI Algorithm
Careful analysis of coronary angiogram / MSCT
In-stent restenosis
Proximal cap ambiguity
No
Poor quality distal vessel
• Previous failed attempt
Consider stopping if > 3 hr; 3.7x eGFR ml contrast; Air Kerma > 5 Gy unless procedure well adv6 anced.
CTO介入治疗策略的选择
Corsair + Fielder XT
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
Proximal cap ambiguity
No
Poor quality distal vessel
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
一百个观众心中就有一百个哈姆雷 特，与之相似，不同的术者，就有 不同的手术策略……,尽管手术策略 多种多样，但仍然有规律可循！
3
AP CTO Club PCI Algorithm
Ca来自百度文库eful analysis of coronary angiogram / MSCT
In-stent restenosis
4e.scala忽tion略了IV(crUossSbo在ss-sCtinTgrOay) PCIe中scal的atio作n 用 (reverse CART)
5. 过分强调了ADR技术
Brilakis ES et al. JACC Cardiovasc Interv 2012
2
CTO介入治疗策略的选择
No
Antegrade wire based approach
No IF Antegrade approaches Failed
Yes
Retrograde approach
Parallel wiring +/-
IVUSguided wiring
If suitable
reentry zone
Successful crossing
(CrossBoss /
Stingray
Successful crossing
Features favouring early use of dissection-reentry:
• Ambiguous course in CTO • Length > 20 mm
• Tortuous CTO segment • Heavy calcification • Length > 20 mm
Dissectionreentry
Features favouring early use of dissection-reentry:
• Ambiguous course in CTO
(CrossBoss /
• Length > 20 mm • Tortuous CTO segment
Stingray
• Heavy calcification
• Length > 20 mm
• Previous failed attempt
Consider stopping if > 3 hr; 3.7x eGFR ml contrast; Air Kerma > 5 Gy unless procedure well advanced.
CTO介入治疗策略的选择
复旦大学附属中山医院心内科 上海市心血管病研究所 葛雷
1
CTO介入治疗策略的选择
The Hybrid Algorithm for CTO PCI in USA
1. 仅仅评价了CTODu正al C向athe的ter 解Ang剖iogra结phy构，对侧枝血管
的评估不够 yes 1. Clear proximal cap
no
2. Good Distal Target
2. 正A向nte技grad术e 和逆向技术的相互转化R条etro件grad不e 够细化
3. ye忽s 略了平no行导引3.钢Len丝gth技< 20术mm yes
no
Wire
Dissection Reentry
Wire
Dissection Reentry
In-stent restenosis
Proximal cap ambiguity
No
Poor quality distal vessel
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
No
Antegrade wire based approach
No IF Antegrade approaches Failed
Yes
Retrograde approach
Parallel wiring +/-
IVUSguided wiring
If suitable reentry zone
Dissectionreentry
060235
CTO介入治疗策略的选择
Gaia First
8
060235
CTO介入治疗策略的选择
Stenting and Final Result
9
060235
CTO介入治疗策略的选择
Case 2: Male, 69 yrs
10
68323
CTO介入治疗策略的选择
11
68323
CTO介入治疗策略的选择
CTO介入治疗策略的选择
Case 1: Male, 47 yrs
Tiny stump, healthy distal vessel, length <20mm
5
060235
AP CTO Club PCI Algorithm
Careful analysis of coronary angiogram / MSCT
7F EBU 3.5
12
68323
AP CTO Club PCI Algorithm
Careful analysis of coronary angiogram / MSCT
In-stent restenosis
Proximal cap ambiguity
No
Poor quality distal vessel
• Previous failed attempt
Consider stopping if > 3 hr; 3.7x eGFR ml contrast; Air Kerma > 5 Gy unless procedure well adv6 anced.
CTO介入治疗策略的选择
Corsair + Fielder XT
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
Proximal cap ambiguity
No
Poor quality distal vessel
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
一百个观众心中就有一百个哈姆雷 特，与之相似，不同的术者，就有 不同的手术策略……,尽管手术策略 多种多样，但仍然有规律可循！
3
AP CTO Club PCI Algorithm
Ca来自百度文库eful analysis of coronary angiogram / MSCT
In-stent restenosis
4e.scala忽tion略了IV(crUossSbo在ss-sCtinTgrOay) PCIe中scal的atio作n 用 (reverse CART)
5. 过分强调了ADR技术
Brilakis ES et al. JACC Cardiovasc Interv 2012
2
CTO介入治疗策略的选择
No
Antegrade wire based approach
No IF Antegrade approaches Failed
Yes
Retrograde approach
Parallel wiring +/-
IVUSguided wiring
If suitable
reentry zone
Successful crossing
(CrossBoss /
Stingray
Successful crossing
Features favouring early use of dissection-reentry:
• Ambiguous course in CTO • Length > 20 mm
• Tortuous CTO segment • Heavy calcification • Length > 20 mm
Dissectionreentry
Features favouring early use of dissection-reentry:
• Ambiguous course in CTO
(CrossBoss /
• Length > 20 mm • Tortuous CTO segment
Stingray
• Heavy calcification
• Length > 20 mm
• Previous failed attempt
Consider stopping if > 3 hr; 3.7x eGFR ml contrast; Air Kerma > 5 Gy unless procedure well advanced.
CTO介入治疗策略的选择
复旦大学附属中山医院心内科 上海市心血管病研究所 葛雷
1
CTO介入治疗策略的选择
The Hybrid Algorithm for CTO PCI in USA
1. 仅仅评价了CTODu正al C向athe的ter 解Ang剖iogra结phy构，对侧枝血管
的评估不够 yes 1. Clear proximal cap
no
2. Good Distal Target
2. 正A向nte技grad术e 和逆向技术的相互转化R条etro件grad不e 够细化
3. ye忽s 略了平no行导引3.钢Len丝gth技< 20术mm yes
no
Wire
Dissection Reentry
Wire
Dissection Reentry
In-stent restenosis
Proximal cap ambiguity
No
Poor quality distal vessel
Yes Yes
Yes
Use of CrossBoss as primary crossing strategy
IVUS-guided entry
No
Interventional collaterals present
No
Antegrade wire based approach
No IF Antegrade approaches Failed
Yes
Retrograde approach
Parallel wiring +/-
IVUSguided wiring
If suitable reentry zone
Dissectionreentry