开口及分叉病变

Bifurcation stent…latest…
Bifurcation Stenting:
A whole new direction.
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Aorto-Ostial Lesions: Guiding Catheter Selection
The key to success is co-axial alignment, not
a “power position.” Remember that sidehole guides will permit passive perfusion and reduce pressure damping and ischemia, but do NOT prevent vessel injury.
Aorto-Ostial Lesions: Stent
ቤተ መጻሕፍቲ ባይዱ
A. Position the stent-delivery balloon so 1 mm of stent extends into the aorta. The guide must be retracted 1-2 cm before deploying the stent. B. After stent deployment, remove the delivery balloon while maintaining backward tension on the guide to prevent it from advancing into the ostium and damaging the stent. C. Perform adjunctive PTCA with a high pressure balloon; consider IVUS to ensure full stent expansion and apposition. Flaring the proximal end of the stent with a slightly larger balloon is useful.
TYPE 3: Parent vessel stenosis distal to bifurcation
Sidebranch involved
Sidebranch normal
Classification of Bifurcation Lesions
TYPE 4: Parent vessel is normal; Ostial sidebranch stenosis
Frontier Registry: MACE
Frontier Registry: QCA Analysis
Frontier Registry: QCA Analysis
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OTW wire is advanced into the side branch
System is advanced into position
Simultaneous kissing balloon inflation is performed
Final Deployed Stent – Wire positions maintained
Aorto-Ostial Lesions: Calcified RCA
PRE
POST ROTA/PTCA
Aorto-Ostial Lesions: SVG to LAD
PRE
POST
Branch-Ostial Lesions: Diagonal Branch
PRE
POST - DCA
Branch-Ostial Lesions: Origin LAD
PRE
POST-DCA
分叉处病变
Bifurcation Lesions: Risk of Sidebranch Occlusion (SBO)
Anatomy Branch normal, originates near target lesion Branch normal, originates from target lesion Branch stenosis > 50%, originates from target lesion SBO (%) <1 2 - 10 15 - 35 SB Protection No Yes, for large branches Yes
DES
DES
Approach to Aorto-Ostial Lesions (Significant calcification)
Consider IVUS for sizing, assessment of extent of Ca++ Rotablator *
DES
* Cutting balloon is not a suitable substitute for most calcified stenoses.
Aorto-Ostial Lesions: Guiding Catheter Technique
Active manipulation of guiding catheter is essential!
Aorto-Ostial PTCA: WatermelonSeeding
SOLUTION: Long balloons (30-40 mm) Cutting balloon Rotablator (calcified lesions)
Approach to Aorto-Ostial Lesions (No calcification)
Vessel 2.5 mm
Vessel < 2.5 mm
Rotablator Cutting balloon PTCA
Rotablator Cutting balloon PTCA or DCA
PCI Technique
New Modality for Bifurcation lesion

Special Design Bifurcation stent Drug eluting Stent
Solution 1:Bifurcation stent
Classification of Bifurcation Lesions
TYPE 2: Parent vessel stenosis proximal to bifurcation
Sidebranch involved
Sidebranch normal
Classification of Bifurcation Lesions
开口及分叉处病变
北京大学第一医院 霍勇
开口处病变
Ostial Lesion Classification
Aorto - ostial
Junction between the aorta and orifice of the RCA, SVG, or LM
Branch Ostial
Junction between a large epicardial vessel and its branch; also called “origin” lesion
Guidant Frontier Stent….
System is advanced over RX wire in main vessel
Joining mandrel is retracted and tips released
OTW Lumen is re-wired with a 300cm guide wire
Aorto-Ostial Lesions: DCA
Proper technique requires gentle retraction of the guiding catheter 2-3 cm into the aorta prior to cutter activation. It is important to establish other landmarks (rib margins, catheter shaft) to ensure precise positioning of the AtheroCath. Failure to retract the guide may result in partial excision of the tip of the guide during cutter activation.
Aorto-Ostial Lesions: Rotablator
Proper technique involves selection of a guiding catheter that provides ideal coaxial alignment and use of a Rotablator support guidewire. After crossing the lesion with the guidewire, allow the guide to gently “kickout” of the ostium to facilitate ablation of the ostial lesion. The platform speed should be adjusted in the guiding catheter. Remove all slack in the guidewire to avoid kinking at the ostium.
Classification of Bifurcation Lesions
TYPE 1: Parent vessel stenosis proximal and distal to bifurcation
Sidebranch involved (True bifurcation lesion)
Sidebranch normal