支架内再狭窄IVUS知识讲解

Final Angiography
Angiography of Mar 15, 2010
RCA and LAD Stenting
3.0×13mm Firebird 12atm
3.0×18mm Firebird 12atm
Final Angiography
Angiography of Feb 11, 2015
Vasim Farooq, et al. The PCR-EAPCI Textbook – Percutaneous Interventional Cardiovascular Medicine In-stent Restenosis.
Findings of IVUS for ISR
➢Stent Underexpansion: Final Stent Area：
2.75×17mm SeQuent Please DCB 14atm 40s
Final Angiography
RCA Final IVUS
MLA=4.09mm2
Definition
Importance of IVUS for ISR
Use of IVUS in ISR
Evaluation for the patterns and mechanism
RCA IVUS
MLA=2.51mm2
RCA IVUS
Proximal reference Proximal stent Mid stent Distal stent Distal reference
Proximal
Underexpansion ?
Distal
RCA Intervention
2.5×15mm Maverick 10atm
Strategies for ISR Treatment
DCB or DES
Summary
➢Current restenosis rates are lower than ever
but can still present a challenge
➢We will treat restenosis differently based
Guide the treatment selections
Angiographic ISR Classification
confirmed by IVUS
( < 10 mm )
( > 10 mm )
Mehran, et al. Circulation. 1999;100:1872-1878
Mechanisms of DES Restenosis
Strut Distribution，DES Damage
➢Intimal Hyperplasia
Treatment Options of DES ISR
➢Balloon PTCA (also "Cutting " Balloon) ➢Drug-Coating Balloons ➢Drug-Eluting Stents (DES): Same or Different? ➢Bioresorbable Scafford ➢Bare Metal Stent (BMS) ➢Brachytherapy (VBT) ➢Rotablation (RA) / Laser ➢Medical Management ➢CABG
made PCI strategy is important
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支架内再狭窄IVUS
Angiography of Oct 29, 2009
RCA Predilatation
1.5×15mm sprinter 8atm
2.0×15mm sprinter 10atm
RCA Stenting
Байду номын сангаас
3.0×30mm Endeavor 12atm
3.0×30mm Endeavor 14atm
MSA≤5mm2, Stent length
➢Stent Edge Restenosis ➢Stent Fracture ➢DES Gap or Geographic Miss (Incomplete
stent coverage)
➢Non-Uniform Stent Expansion: Non-uniform
upon the mechanism
➢The current main cause of ISR is stent
underexpansion in difficult lesions such as calcified, long, small vessels
➢For complex lesions, IVUS guided tailor-