冠状动脉造影ABC

1、冠心病介入诊疗-ABC1929年,德国医生Wenner Forssmann在自己身上进行了人类首例心导管检查术. 他将导管经左肘前静脉,锁骨下静脉,上腔静脉送入右心房,并拍了医学史上第一张右心导管胸片,从此揭开了介入心脏病学的序幕.1959年Mason Sones 利用特制的尖端呈弧形的造影导管,经肱动脉送入主动脉根部进行主动脉造影,无意中将造影剂直接注入右冠状动脉内使其清晰显影,这一偶然事件开创了冠脉介入诊断技术的新纪元1950s1960s1970sRyan Circulation 2002, 106:752-7561980s1990sRyan Circulation 2002, 106:7

2、52-7562013股神经股总动脉股静脉穿刺位置股骨头腹股沟韧带尺动脉桡动脉肱动脉桡动桡动脉脉掌浅弓掌浅弓尺尺动动脉脉Barbeau. G et al; Am Heart J 2004;147:489932 minBarbeau. G et al; Am Heart J 2004;147:48993NOJudkinsAmplatzTiger 导管导管JR4 导管导管左主干左主干(LM) 左前降支左前降支(LAD) 对角支对角支(D1, D2) 间隔支间隔支(septal) LADD1SeptalD2LMSRCAPLVINFPDAAM Radiographics 2007;27:1569-158

3、2Radiographics 2007;27:1569-1582Marginal branchConus branchMarginal branch回旋支回旋支 (Cx) 钝缘支钝缘支 (OM1, OM2)OM1CXOM2LAD Radiographics 2007;27:1569-1582OMOMLMSCXCXOMRadiographics 2007;27:1569-1582IMCXLMS后侧支(PL)后降支(PD)左主干起源于右冠窦http:/www.radiologyassistant.nl/en/48275120e2ed5Myocardial bridge in LADhttp:/ww

4、w.radiologyassistant.nl/en/48275120e2ed5A myocardial bridge occurs when one of the coronary arteries tunnels through the myocardium rather than resting on top of the myocardium钙化1234BifurcationOstialTFG0TFG1TFG2TFG3Gibson C M et al. Circulation 1999;99:1945-1950Gibson et al found a mean corrected TF

5、C (cTFC) for normal coronary arteries of 21 3.1 frames, yielding a 95% confidence interval for normal flow of (15, 27) frames.The Frame Count Reserve (FCR) can be calculated by dividing basal by hyperaemic TFC. The Frame Count Velocity (FCV) can be calculated by multiplying the length of the coronar

6、y artery by the acquisition rate (12.5, 25, 30 f/s) and dividing by the TFC. Gibson et al. Circulation 2000; 101:125-13028 | MDT ConfidentialUC201204429EEBrener SJ et al. Circ CV Interv. 2012;5:563-9Farkouh ME et al. Circ CV Interv. 2013;6:216-23心肌灌注分级TIMI血流ST段回落29 | MDT ConfidentialUC201204429EETIM

7、I 3 级血流级血流 无微血管灌注无微血管灌注Henriques JPS et al. EHJ 2002;23:1112-7Gibson CM et al. Circulation. 2001;103:2550-2554Grade 5 thrombusGrade 4 thrombus1,1,1Dissection-Type DDissection flap post POBA in a heavily calcified lesion- Type CPerforationPerforationPrePostLADRCAIVUS interrogation has identified IH a

8、s the main cause of ISREur Heart J (2003) 24 (2): 138-150. (2003) 24 (2): 138-150. IVUS provides an attractive technique to characterise fully the pattern of stent thrombosis, to identify readily the underlying mechanical predisposing factors, and to guide repeated coronary interventionsHeart. 2004

9、December; 90(12): 14551459AEDCBFCase example of a 59 year old woman who presented with CS in the setting of STEMI (late presentation with ongoing symptoms). Initial angio showed thrombus LMS, CX (Panel A- arrow). Export aspiration cleared the thrombus (Panel B) with evidence of haziness in the ostial LMS (Panel C) confirmed on IVUS as a plaque in ostial LMS (Panel D) which was treated successfully with LMS stenting (Panel E),