血管内超声基础知识PPT学习教案

1、会计学1南方会南方会2008第1页/共49页Rotating ElementDrive ShaftMulti-element Array南方会南方会2008第2页/共49页南方会南方会2008第3页/共49页南方会南方会2008第4页/共49页南方会南方会2008第5页/共49页南方会南方会2008第6页/共49页南方会南方会2008第7页/共49页南方会南方会2008第8页/共49页南方会南方会2008第9页/共49页南方会南方会2008第10页/共49页南方会南方会2008第11页/共49页南方会南方会2008第12页/共49页南方会南方会2008第13页/共49页南方会南方会2008第1

2、4页/共49页EEMGuidewiresIVUS catheterPlaque+mediaLumen南方会南方会2008第15页/共49页EEMLumenStentGuidewireIVUS catheterPlaque+mediaIntimal hyperplasia南方会南方会2008第16页/共49页南方会南方会2008第17页/共49页南方会南方会2008第18页/共49页南方会南方会2008第19页/共49页南方会南方会2008第20页/共49页Focal Disease50% Lesion50% LesionDiffuse DiseaseAngiogram Silhouette南方

3、会南方会2008第21页/共49页南方会南方会2008第22页/共49页Compenatory ExpansionMaintains Consistant LumenExpansionOvercome: Lumen NarrowsNormal VesselMinimal CADModerate CADSevere CAD南方会南方会2008第23页/共49页南方会南方会2008第24页/共49页ACross-sectionRAO ViewLAO ViewBC南方会南方会2008第25页/共49页IVUS EEM CSA = 22.7mm2 Lumen CSA = 16.6mm2 Mean lu

4、men diameter = 4.6mmQCA 9F guiding catheter Reference diameter = 3.12mm南方会南方会2008第26页/共49页南方会南方会2008第27页/共49页IVUS MLA 4.0mm2IVUS MLA 4.0mm2CFR 2.0227CFR 2.0394Diagnostic accuracy = 92%. Abizaid et al, AJC 1998;82:42-8IVUS MLA 4.0mm2IVUS MLA 4.0mm2+ Spect442- Spect201Diagnostic accuracy = 93%. Nishio

5、ka et al, JACC 1999;33:1870-8南方会南方会2008第28页/共49页南方会南方会2008第29页/共49页(Cameron et al. Circulation 1983;68:484-489)Five grades of LM severity1: 0-24% DS2: 25-49% DS3: 50-74% DS4: 75-89% DS5:90-100%DS# of grades of difference in assessment of LM severity 0:no difference+1 or -1:1 grade difference+2 or -2

6、:2 grades of difference+3 or -3:3 grades of difference+4 or -4:4 grades of difference南方会南方会2008第30页/共49页ReferenceLesion10 mm南方会南方会2008第31页/共49页南方会南方会2008第32页/共49页TrueAneurysmPSAComplexPlaqueNormal Site withAdjacent StenosesNo prior PCI100626Prior PCI113615南方会南方会2008第33页/共49页南方会南方会2008第34页/共49页The hi

7、gh predictive value (90%) for the minimum stent CSA in Cypher stents suggests that most causes of Cypher stent failure will be “mechanical”(Sonoda et al. J Am Coll Cardiol 2004;43:1959-63)南方会南方会2008第35页/共49页40mm17.7%8.6%南方会南方会2008第36页/共49页0246810121402468101214IVUS Measured MSA (mm2)Predicted MSA (m

8、m2)012345012345IVUS Measured MSD (mm)Predicted MSD (mm)南方会南方会2008第37页/共49页南方会南方会2008第38页/共49页TwoOverlappingStentsHazySegment南方会南方会2008第39页/共49页Stent南方会南方会2008第40页/共49页UltrasoundSiteStent南方会南方会2008第41页/共49页南方会南方会2008第42页/共49页南方会南方会2008第43页/共49页Virtual HistologyTM Volcano南方会南方会2008第44页/共49页Virtual His

9、tologyTM VolcanoFIBROTICFIBRO-LIPIDCALCIFICLIPID COREMEDIALegendMa xP -2 5.05Typ e: C olla ge n# of RO Is : 2 6Int -28 .65# of RO Is : 3 1Int -14 .8Typ e: C olla ge n# of RO Is : 5F at Ma xP 21 .04 5Typ e: C olla ge n# of RO Is : 1 7MB F -6 5.0 9# of RO Is : 2 7Int -4.1 95Typ e: C olla ge n# of RO I

10、s : 5MB F -6 5.0 9# of RO Is : 1 1F at Ma xP 30 .03# of RO Is : 3 8Ma xP -1 6.09 5Typ e: C olla ge n# of RO Is : 6F at Ma xP 34 .27 5Typ e: N ecr otic# of RO Is : 6MB F -6 6.6 5Typ e: C olla ge n# of RO Is : 5Ma xP -1 2.14 5Typ e: Fib ro -Lipidic# of RO Is : 5F at Ma xP 34 .27 5# of RO Is : 1 5Ma xP

11、 -9 .9 15# of RO Is : 2 1F at Ma xP 35 .5Typ e: C olla ge n# of RO Is : 9Ma xP -9 .9 15# of RO Is : 1 7Ma xP -1 6.09 5# of RO Is : 3 8F at Ma xP 30 .03# of RO Is : 4 4Int -28 .65# of RO Is : 8 2MB F -5 5.6 95# of RO Is : 1 13MinP -1 7 .9 15Typ e: C olla ge n# of RO Is : 5MB F -5 3.1 5Typ e: C alciu m# of RO Is : 2 0MinP -1 7.9 15# of RO Is : 2 8MB F -5 5