支架内再狭窄 -IVUS

Importance of IVUS for ISR
Use of IVUS in ISR
Evaluation for the patterns and mechanism Guide the treatment selections
Angiographic ISR Classification
confirmed by IVUS
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 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 tailormade PCI strategy is important
RCA Stenting
3.0×30mm Endeavor 12atm 3.0×30mm Endeavor 14atm
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
RCA IVUS
MLA=2.51mm2
RCA IVUS
Proximal reference Proximal stent
Mid stent
Distal stent
Distal reference
Proximal
( < 10 mm )
( > 10 mm )
Mehran, et al. Circulation. 1999;100:1872-1878
Mechanisms of DES Restenosis
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：
MSA≤5mm2, Stent length
Stent Edge Restenosis Stent Fracture DES Gap or Geographic Miss (Incomplete
THANK YOU
rest
In 2009, RCA stents for old inferior myocardial
infarction (7 months ago) and unstable angina
In 2010, repeat PCI for RCA and LAD because of
unstable angina
History of Dislipidemia and hypothyroidism, smoker Diagnosis: unstable angina
Angiography of Oct 29, 2009
RCA Predilatation
1.5×15mm sprinter 8atm 2.0×15mm sprinter 10atm
stent coverage) Non-Uniform Stent Expansion: Non-uniform
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
Underexpansion ?
Distal
RCA Interve源自文库tion
2.5×15mm Maverick 10atm
2.75×17mm SeQuent Please DCB 14atm 40s
Final Angiography
RCA Final IVUS
MLA=4.09mm2
Definition
IVUS指导下处理支架内再狭窄1例
IVUS-Guided PCI for the Patient with ISR
浙江省中医院心内科
蔡宏文
History Summary
67 year old male Presented with developed recurrent chest pain at