非顺应性球囊后扩张临床益处沙龙

非顺应性球后扩张的临床益 2vs.IVUSIVUS显示支架

1支架1支架植入效果理想标vs.床现支架未完全扩张和贴壁不带来的风23非顺应性球囊后扩张的临床益间隙 支架是否完全贴 支架是否完全扩*5POSTIT研究显示，71%支架未完全扩

最小支架直径

支架完全扩 支架未完全扩IsadjunctiveballoonPostdilatationNecessaryaftercoronarystentdeployment?FinalresultsfromthePOSTITTrail,BruceR.Brodie,MD CatheterizationandCardiovascularInterventions59:184-19220036POSTIT研POSTIT研究显示，即使在高压下），仍有64%的支架未完全扩Cheneau等研究显示，即使在高压下，仍有40%的支架未完全扩

最小支架面积

12-14

IsadjunctiveballoonPostdilatationNecessaryaftercoronarystentdeployment?FinalresultsfromthePOSTITTrail,BruceR.Brodie,MD CatheterizationandCardiovascularInterventions59:184-1922003Underexpansionofsirolimus-elutingstents:Incidenceandrelationshiptodeliverypressure,EdouardCheneau,CatheterizationandCardiovascularInterventions65:222-226支架内球囊扩张后MSA＜预期目标IntravascularIntravascularultrasoundassessmentofdrug-elutingstent研究入组200名病患，其中133名病患植入SES支架，67名病患植入PES支

IVUS测得IVUS测得支架直径比预期支架直

最终支架释放的压

Intravascularultrasoundassessmentofdrug-elutingstentexpansion,JosedeRibamarCosta,AmericanHeartJournal,February 研究显示支架贴壁不良发生率达

8

pletestentappositionaftersirolimus-elutingstentimplantation:Aserialintravascular JunyaAko,JournaloftheAmericanCollegeofCardiology,Vol.46,No.6, 理想的支架植与临床实际支架植入存在差临临床实际中存在支架未完全扩张和贴壁不即即使在高压下，支架球囊较难使支架完全11vs.23支架血支架再狭支架支架血支架再狭支架未完全扩是亚急性血栓的独立预测因该研究比较15名DES支架内血栓的患者和45名无支架血栓的患者，对照组的MSA显著大于血栓组6.2vs4.3）;照组的支架膨胀情况显著优于血栓组（85%vs65%）

最小支架管腔面积 7

0

Stentunderexpansionandresidualreferencesegmentstenosisarerelatedtostentthrombosisaftersirolimus-elutingstentimplantation:Anintravascularultrasoundstudy，KenichiFujii,MDJournalofAmericanCollegeofCardiologyVol.45,No.7,支架贴壁不Cook等10人研究发现晚期血栓组的支Cook等10人研究发现晚期血栓组的支架贴壁不良发生率明显高于DES

Pt.123456789ISA94444726pleteStentAppositionandVerylateStentThrombosisAfterDrug-ElutingImplantation,Stephane May8,支架未完全扩WashingtonHospitalCenter分析1000多例ISR（支架WashingtonHospitalCenter分析1000多例ISR（支架内再狭窄）患者，研究显示20支架未完全扩

0支架内再狭窄病 支架未完全扩张病Thecontributionof“mechanical”problemstoin-stentrestenosis:Anintravascular ysis1090consecutivein-stentrestenosislesion.MarcoT.Castagna,AmericaHeart December 支架球囊高压扩张增加TLR风VavuranakisVavuranakis等研究显示，支架内球囊高压扩张易产生“狗骨头”现象，导致支架展开匀，从而带来TLR风险

After After

支架内最小直径

6个月Stentdeploymentincalcifiedlesions:canwe ecalcificrestraintwithhigh-pressureballooninflations?VavuranakisM, CatheterCardiovascInterv2001;52:164–72. 支支架未完全扩张是亚急性血栓的独立预测支架支架未完全扩张和贴壁不良是支架内血栓和再狭窄重要支架球囊的高压扩张增加TLR风11vs.23支架球囊较难完全扩张支架的原vs.

非顺应A.14a:，非顺应性球.B.14atm下，半顺应性球非顺应性球囊后扩显著改善了支架的扩张情 IVUS：使用NCSprinter后非顺应性球囊NCSprinter非顺应性球囊后可提高支架最佳释放入选15名再狭窄病患，分别在支架植入后及高压扩张后进行IVUS入选15名再狭窄病患，分别在支架植入后及高压扩张后进行IVUS

最小支架面积 before afterUsefulnessofhigh-pressurepost-dilatationtooptimizedeploymentofdrug-elutingstentsforthetreatmentofdiffusein-stentcoronaryrestenosis,DanielJ.Blackman,MDTheAmericanJournalofCardiologyVol.94October1,非顺应性球囊后Daniel等研究，入选15名支架内再Daniel等研究，入选15名支架内再狭窄病患，分别在支架植入后以及高压扩张后进行IVUS评估非顺应性球囊后扩后，最小管腔面积提高30%，11个月随访显示没有发生支架内狭beforebefore after

003 Usefulnessofhigh-pressurepost-dilatationtooptimizedeploymentofdrug-elutingstentsforthetreatmentdiffusein-stentcoronaryrestenosis,DanielJ.Blackman,TheAmericanJournalofCardiologyVol.94October1, 后扩张可降低TVR的发生 造影 N

6 20

FinalResultsoftheCanRoutineUltrasoundInfluenceStentExpansion(CRUISE)Study,PeterJ.Fitzgerald,MD August1,2000后扩张可降低TLR风TULIPTULIP研究显示，6个月随访，IVUS指导组最小管腔直径MLD要显著大于造影指导组的TLR发生率明显小于造影组

0

Intravascularultrasoundguidanceimprovesangiographicandclinical eofstentimplantationforlongcoronaryarterystenoses：finalresultsofarandomizedcomparisonwithangiographicguidance(TULIPStudy).OemrawsinghPV,Circulation2003Jan7;107(1):62-7.（含钙化、纤维化等

放置支架

IVUS=intravascularMLD=minimumlumendiameter 最小管腔直径MLA=minimumlumenarea MSA=minimumstentd