冠脉长病变的处理课件

1、冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理 lrp8冠脉长病变的处理冠脉长病变的处理KokuraKokura纪念医院的经验纪念医院的经验冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理长病变长病变(20mm)(20mm)3.0mm3.0mm3.0mm50%50%支架支架推荐单个长支架推荐单个长支架冠脉长病变的处理冠脉长病变的处理Tan K,etal.Clinical and lesion morphologic determinants of coronary angioplasty success and complications:Cu

2、rrent experience.J Am Coll Cardiol 1995;25:855-865冠脉长病变的处理The M-HEART investigators.J Am Coll Cardiol 1991;18:647-6560.3-2.90.3-2.93.0-4.63.0-4.64.7-7.04.7-7.07.1-28.07.1-28.0冠脉长病变的处理冠脉长病变的处理4 4个支架个支架3 3个支架个支架2 2个支架个支架1 1个支架个支架再狭窄率（再狭窄率（% %）病变长度（病变长度（mmmm）0102030400.20.30.40.5冠脉长病变的处理冠脉长病变的处理IVUSIVU

3、S与造影指导下放置支架的比较与造影指导下放置支架的比较冠脉长病变的处理Restenosis Rate (%)PTCAStentDES冠脉长病变的处理冠脉长病变的处理In-Stent23.529.736.744.352.41.01.72.64.16.5ControlSirolimus冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理Kim YH. Long DES-II investigator, Circulation, 2006;114:2148-2153冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的

4、处理Very Late ST? 6 mo to reflect risk of ST after Plavix stoppedLate STSAT24 hours to 30 days24 HoursST = stent thrombosis; SAT = subacute stent thrombosis;LST = late stent thrombosis; VLST = very late stent thrombosis.Adapted from Bhatt. J Invasive Cardiol. 2003;15(suppl B):3B.Acute ST1 to 6 months

5、(on Plavix)冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理冠脉长病变的处理ENDEAVOR IENDEAVOR IIENDEAVOR II CAENDEAVOR IIIENDEAVOR PKSingle Arm First-in-Man (n=100) 4yr1:1 RCT vs. BMS (E=598,D=599) PK (n=106) 3yrContinued Access Single Arm (n=296) 2yr3:1 RCT vs. Cypher (E=323,C=113) 2yrPharmacokinetic Study (n=43) 9moSingle Arm (n=99) 9moENDEAVOR JapanE-FIVEOpen Label Single Arm (n=8000)US Post ApprovalPROTECT 1:1 RCT vs. Cypher (E=4400,C=4400)Open Label Single Arm Study (n=2000)Proposed Ongoing Prema