分叉病变PPT课件

baseline
LCx Taxus 2.75/16mm
OM Taxus 2.5/12mm
LM Taxus 3.5/16mm
LCx os Post-stenting Taxus 3.0/8mm
2nd day, Repeat Angio
27
After Re-PTCA, kissing
6-Month Clinical Follow-up
Main Vessel Side Branch
%DS pre- 84.5 ± 11.5 84.0 ± 10.2
20
17.9±9.3 %DS post-
0.4 ± 2.3
1.2± 3.1
15
10.4±4.5
10
5
3.32±0.45 2.86±0.34
0 RVD
Lesion Length
2.81±0.34 3.31±0.45 0.46±0.30 0.51±0.41
Strategy for Bifurcation Lesion
分叉病变治疗策略评述
Prof. Chen Jilin
Cardiovascular Institute & Fuwai Hospital Peking Union Medical College
Chinese Academy of Medical Sciences
Male 59(83.1%), age 57.0yrs(38~77)
20
Baseline Characteristics
N
%
Prior MI
21
29.6
Prior PCI
17
23.9
Prior CABG
2
2.8
Diabetes
11
15.5
Hypertension
38
53.5
Hyperlipidemia
AT & SAT
8 (4.4%)
TLR
27 (14.9%)
CAG.R
145 (80%)
Res.R
11.5%(MV)
11.1%(SB with FKB)
37.9%(SB non-FKB)
* kissing-balloon can improve the results
Colombo A, et al. JACC, 2005 Aug 16; 46(4): 621 18
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
0.0 Death
1.4
1.4
1.4
1.4
0 AMI CABG REPCI SAT MACE
* Same patient with LCx/OM bifurcation treated with Crush stenting without FKBT, Q-wave MI (2nd day) – Repeat Angio – SAT and 100% @ OM – Re-PTCA suc2c6ess
1
Classification of Bifurcation Lesion
3
Duke Classification
4
PCR Classification
-1998, Paris5
Modified Classification
Dr. Jilin Chen, Fu Wai Hospital
Ia
Ib
28
39.4
21
Target Lesion
பைடு நூலகம்
Lesion number 40
35
30
25
20
20
15
10
5
0 distal LM
45 LAD/Diag.
6 LCx/OM
1 RPL/PD
22
Stenting Technique Used
6
4
Lesion number
45
41
16
Crush
Reverse Crush
( Colombo A, et al. JACC, 2005 Aug 16; 46(4): 621 )
19
Bifurcation stenting technique in the era of DES at Fuwai
Oct. 2003 - Feb. 2005, 71 pts with 72 true bifurcation lesions treated by double stenting technique
3.5
6-month Clinical Follow-up
was finished in 71 patients
6.0
5.0
4.0
2.8
2.8
3.0
2.0
1.0
0
0
0
0
0.0 Death AMI CABG REPCI SAT MACE
28
baseline 8m later
Post-
LAD Taxus 3.0/28mm Diag. Taxus 2.75/16mm
29
Modified Classification of Bifurcation Lesion
Ic
Id
Type I
IIa Type II
IIb
IIc
IId
Type III
Depends on whether ostium of side branch is involved or not
6
Crush for Bifur L
Clinical F/U (9m): 181 cases
Death
0
Inverse Crush
Step Crush
40
16
35
30
25
19
Final Kissing Balloon Technique was
20
performed in 51(85%) lesions!
15
10
5
3
3
5
0 Any Crush "T" Modify "V" Culotte "Y"
23
Target Lesion Analysis
MLD pre- MLD post-
Main Vessel Side Branch
24
Stents
60
59
50
40
30
20
10
0 Cypher
Stent Usage
84.6% of total stents were DES
48
25
24
Taxus
Firebird
BMS
25
In Hospital Outcome
Conclusions
Compared to the absence of FKB, the “crush” stenting technique with FKB appears to be associated with more favorable long-term outcomes.
When utilizing the “crush” stenting technique, FKB is mandatory.