冠状动脉造影abc课件

冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件11959年MasonSones

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1959年MasonSones利用特制的尖端呈弧形的造影2冠脉造影50余年的历程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脉造影)

Thefirsthumanstudies-severityandextentofCAD(首个人体研究)EarliestnaturalhistorystudiesofprovenCAD    DynamicvisualizationofLVperformance(左室造影)

DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronaryvasospasmandPrinzmetal’sangina(冠脉痉挛)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狭窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:752-756冠脉造影50余年的历程!CAintroducedbyF3冠脉造影50余年的历程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小时内的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治疗斑块消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的发病机制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分级)Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脉造影50余年的历程!Thrombolyticera,4冠脉造影

股动脉及桡动脉路径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冠脉造影

股动脉及桡动脉路径股神经股总动脉股静脉穿刺位置股骨5解剖学桡动脉掌浅弓尺动脉解剖学桡动脉掌浅弓尺动脉6Allen试验Allen试验7Allen试验解读Allen试验解读8AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minAssementofulnararchbyoxym9Barbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscoreBarbeau.Getal;AmHeartJ210冠脉造影

导管JudkinsAmplatzTiger导管JR4导管冠脉造影导管JudkinsAmplatzTiger导管J11冠脉解剖学左主干(LM)左前降支(LAD)对角支(D1,D2)间隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脉解剖学左主干(LM)LADD1SeptalD2LMSR12左前降支Radiographics2007;27:1569-1582左前降支Radiographics2007;27:15613Radiographics2007;27:1569-1582右冠状动脉MarginalbranchConusbranchMarginalbranchRadiographics2007;27:1569-15814回旋支回旋支(Cx)钝缘支(OM1,OM2)OM1CXOM2LAD回旋支OM1CXOM2LAD15Radiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics2007;27:1569-1516Radiographics2007;27:1569-1582中间支IMCXLMSRadiographics2007;27:1569-15817右优势:

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左优势:

ThisoccurswhenallthreebranchesarisefromtheCX.冠脉优势型后侧支(PL)后降支(PD)右优势:冠脉优势型后侧支(PL)后降支(PD)18冠脉起源异常左主干起源于右冠窦radiologyassistant.nl/en/48275120e2ed5冠脉起源异常左主干起源于右冠窦radiologyassist19心肌桥MyocardialbridgeinLADradiologyassistant.nl/en/48275120e2ed5Amyocardialbridgeoccurswhenoneofthecoronaryarteriestunnelsthroughthemyocardiumratherthanrestingontopofthemyocardium心肌桥MyocardialbridgeinLADrad20冠脉造影提供的信息定量冠脉造影分析冠脉血流心肌灌注其他特性:钙化血栓溃疡夹层动脉瘤钙化冠脉造影提供的信息定量冠脉造影分析钙化21定量冠脉造影分析(QCA)1近端参考血管直径:2.最小直径:3.远端参考血管直径:4.病变长度:直径狭窄:1234定量冠脉造影分析(QCA)1近端参考血管直径:123422病变特征描述偏心:Theplaqueistwiceaslargeononesideofthearterialbordercomparedwiththeother.钙化:Readilyapparentdensitiesnotedwithintheapparentvascularwallatthesiteofthestenosis.弥漫:Lesionis≥20mminlength.分叉:Atheroscleroticplaqueinvolvestheoriginoftwoseparatearteries.开口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病变特征描述偏心:Theplaqueistwice23TIMI血流分级TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分级TIMIFlowgrade:TFG0T24TIMI计帧TIMIFrameCount:GibsonCMetal.Circulation1999;99:1945-1950GibsonetalfoundameancorrectedTFC(cTFC)fornormalcoronaryarteriesof213.1frames,yieldinga95%confidenceintervalfornormalflowof(15,27)frames.TheFrameCountReserve(FCR)canbecalculatedbydividingbasalbyhyperaemicTFC.TheFrameCountVelocity(FCV)canbecalculatedbymultiplyingthelengthofthecoronaryarterybytheacquisitionrate(12.5,25,30f/s)anddividingbytheTFC.TIMI计帧TIMIFrameCount:Gibson25TIMI心肌灌注分级TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分级TIMIMyocardialPer26直接PCI后，虽然心外膜冠状动脉血流率高，但再灌注未成功BrenerSJetal.CircCVInterv.2012;5:563-9FarkouhMEetal.CircCVInterv.2013;6:216-23心肌灌注分级TIMI血流ST段回落直接PCI后，虽然心外膜冠状动脉血流率高，但再灌注未成功Br镜下远端栓子和无复流

TIMI3级血流

无微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7镜下远端栓子和无复流

TIMI3级血流无微血管灌注He血栓分级Grade0:Nocine-angiographiccharacteristicsofthrombuspresent.Grade1:Hazy,possiblethrombuspresent.Angiographydemonstratescharacteristicssuchasreducedcontrastdensity,haziness,irregularlesioncontour,orasmoothconvex"meniscus"atthesiteoftotalocclusionsuggestivebutnotdiagnosticofthrombus.Grade2:

Thrombuspresent–smallsize:Definitethrombuswithgreatestdimensionslessthanorequalto1/2vesseldiameter.Grade3:

Thrombuspresent–moderatesize:Definitethrombusbutwithgreatestlineardimensiongreaterthan1/2butlessthan2vesseldiameters.Grade4:Thrombuspresent–largesize:AsinGrade3butwiththelargestdimensiongreaterthanorequalto2vesseldiameters.Grade5:Recenttotalocclusion,caninvolvesomecollateralizationbutusuallydoesnotinvolveextensivecollateralization,tendstohavea“beak”shapeandahazyedgeorappearanceofdistinctthrombus.Grade6:Chronictotalocclusion,usuallyinvolvingextensivecollateralization,tendstohavedistinct,bluntcutoff/edgeandwillgenerallyclotuptothenearestproximalsidebranch.GibsonCMetal.Circulation.2001;103:2550-2554Grade5thrombusGrade4thrombus血栓分级Grade0:Nocine-angiogra29动脉瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

Ectasia–visualassessmentofectasia>1&<1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.Grade2:

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.动脉瘤Alocalizedarterialwideni30病变复杂程度AHATaskForceDefinitionasmodifiedbyEllisetal:TypeA:<10mm,discrete,concentricreadilyaccessible,<45degreeanglesmoothcontour,littleornocalcification,lessthantotallyoccluded,notostial,nomajorsidebranchinvolvement,absenceofthrombus.TypeB1:Oneofthefollowingcharacteristics:TypeB2:Twoormoreofthefollowingcharacteristics:10-20mm,eccentric,moderatetortuosityofproximalsegment,irregularcontour,presenceofanythrombusgrade,moderateorheavycalcification,totalocclusion<3monthsold,ostiallesionorbifurcationlesion.TypeC:≥20mmdiffuse,excessivetortuosityofproximalsegment,totalocclusion>3monthsoldand/orbridgingcollaterals,

inabilitytoprotectmajorsidebranches,ordegeneratedveingraftwithfriablelesions. 病变复杂程度AHATaskForceDefinitio31分叉病变:Medina分型1,1,1分叉病变:Medina分型1,1,132夹层分级

Anintraluminalfillingdefectorflapassociatedwithahazy,ground-glassappearance.Thiscategoryissub-classifiedusingtheNHLBIsystemforgradingdissectiontypes:TypeA:Radiolucentareaswithinthecoronarylumenduringcontrastinjection,withminimalornopersistenceofcontrastafterdyehascleared.TypeB:Paralleltractsordoublelumenseparatedbyaradiolucentareaduringcontrastinjection,withminimalornopersistenceafterdyehascleared.TypeC:Contrastoutsidethecoronarylumen,withpersistenceofcontrastintheareaafterdyehascleared.TypeD:Spiralluminalfillingdefectsfrequentlywithextensivecontraststainingofthevessel.TypeE:Newpersistentfillingdefectsthatmaybecausedbythrombus.TypeF:ThesearenonA–Edissectiontypesthatleadtoimpairedflowortotalocclusionofthecoronaryartery.Dissection-TypeDDissectionflappostPOBAinaheavilycalcifiedlesion-TypeC夹层分级 Anintraluminalfillingd33其他穿孔:

Presenceofextra-luminalcontrastthatdevelops duringtheprocedure.分支丢失:

ThedevelopmentofTIMIgrade0or1flowinasidebranchthatwas>1.5mmindiameterpriortotheprocedureandwasinitiallypatentwithTIMIgrade2or3flow.手术成果:

Completesuccess:Ifthepost-procedurevisualresidualstenosisis<50%withnodecrementinflow.Partialsuccess:Ifthereiseithera>50%residualstenosisbyvisualassessmentorifTIMIGrade2Flowisattained(thisincludesTFG2.5).Failure:Ifthereisapersistenttotalocclusion,ifthelesioncannotbecrossed,orifthereispersistentabruptclosure.PerforationPerforationPrePost其他穿孔:PerforationPerforationPr34其他远端栓塞:TheappearanceofanabruptcutoffinthedistalvesselfollowingPTCA.无复流:Markedlydelayedflowdownthearterywithminimalresidualstenosis.其他远端栓塞:35侧枝循环Partial:

Minimalcollateralspresent.Evidenceofminimaltopartialfillingoftherecipientbranchepicardialarteries/infarctregion.Complete:

Well-developedcollaterals.Evidenceofcollateralcirculationwithnearcompletetocompletefillingoftherecipientmajorepicardialartery/infarctregion.LADRCA侧枝循环Partial:LADRCA36支架内再狭窄IVUSinterrogationhasidentifiedIHasthemaincauseofISREurHeartJ(2003)24(2):138-150.支架内再狭窄IVUSinterrogationhasi37支架内血栓IVUSprovidesanattractivetechniquetocharacterisefullythepatternofstentthrombosis,toidentifyreadilytheunderlyingmechanicalpredisposingfactors,andtoguiderepeatedcoronaryinterventionsHeart.2004December;90(12):1455–1459支架内血栓IVUSprovidesanattracti38AEDCBFCaseexampleofa59yearoldwomanwhopresentedwithCSinthesettingofSTEMI(latepresentationwithongoingsymptoms).InitialangioshowedthrombusLMS,CX(PanelA-arrow).Exportaspirationclearedthethrombus(PanelB)withevidenceofhazinessintheostialLMS(PanelC)confirmedonIVUSasaplaqueinostialLMS(PanelD)whichwastreatedsuccessfullywithLMSstenting(PanelE),withwidelypatentstentat3-monthfollow-upangio(PanelF).斑块破裂,血栓形成/急性ST段抬高心梗Cardiogenicshockinwomen.Kunadianetal.ICCL2012RupturedplaquevisibleonangioAEDCBFCaseexampleofa59yea39谢谢！谢谢！40冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件冠状动脉造影abcppt课件411959年MasonSones

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1959年MasonSones利用特制的尖端呈弧形的造影42冠脉造影50余年的历程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脉造影)

Thefirsthumanstudies-severityandextentofCAD(首个人体研究)EarliestnaturalhistorystudiesofprovenCAD    DynamicvisualizationofLVperformance(左室造影)

DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronaryvasospasmandPrinzmetal’sangina(冠脉痉挛)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狭窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:752-756冠脉造影50余年的历程!CAintroducedbyF43冠脉造影50余年的历程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小时内的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治疗斑块消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的发病机制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分级)Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脉造影50余年的历程!Thrombolyticera,44冠脉造影

股动脉及桡动脉路径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冠脉造影

股动脉及桡动脉路径股神经股总动脉股静脉穿刺位置股骨45解剖学桡动脉掌浅弓尺动脉解剖学桡动脉掌浅弓尺动脉46Allen试验Allen试验47Allen试验解读Allen试验解读48AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minAssementofulnararchbyoxym49Barbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscoreBarbeau.Getal;AmHeartJ250冠脉造影

导管JudkinsAmplatzTiger导管JR4导管冠脉造影导管JudkinsAmplatzTiger导管J51冠脉解剖学左主干(LM)左前降支(LAD)对角支(D1,D2)间隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脉解剖学左主干(LM)LADD1SeptalD2LMSR52左前降支Radiographics2007;27:1569-1582左前降支Radiographics2007;27:15653Radiographics2007;27:1569-1582右冠状动脉MarginalbranchConusbranchMarginalbranchRadiographics2007;27:1569-15854回旋支回旋支(Cx)钝缘支(OM1,OM2)OM1CXOM2LAD回旋支OM1CXOM2LAD55Radiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics2007;27:1569-1556Radiographics2007;27:1569-1582中间支IMCXLMSRadiographics2007;27:1569-15857右优势:

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左优势:

ThisoccurswhenallthreebranchesarisefromtheCX.冠脉优势型后侧支(PL)后降支(PD)右优势:冠脉优势型后侧支(PL)后降支(PD)58冠脉起源异常左主干起源于右冠窦radiologyassistant.nl/en/48275120e2ed5冠脉起源异常左主干起源于右冠窦radiologyassist59心肌桥MyocardialbridgeinLADradiologyassistant.nl/en/48275120e2ed5Amyocardialbridgeoccurswhenoneofthecoronaryarteriestunnelsthroughthemyocardiumratherthanrestingontopofthemyocardium心肌桥MyocardialbridgeinLADrad60冠脉造影提供的信息定量冠脉造影分析冠脉血流心肌灌注其他特性:钙化血栓溃疡夹层动脉瘤钙化冠脉造影提供的信息定量冠脉造影分析钙化61定量冠脉造影分析(QCA)1近端参考血管直径:2.最小直径:3.远端参考血管直径:4.病变长度:直径狭窄:1234定量冠脉造影分析(QCA)1近端参考血管直径:123462病变特征描述偏心:Theplaqueistwiceaslargeononesideofthearterialbordercomparedwiththeother.钙化:Readilyapparentdensitiesnotedwithintheapparentvascularwallatthesiteofthestenosis.弥漫:Lesionis≥20mminlength.分叉:Atheroscleroticplaqueinvolvestheoriginoftwoseparatearteries.开口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病变特征描述偏心:Theplaqueistwice63TIMI血流分级TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分级TIMIFlowgrade:TFG0T64TIMI计帧TIMIFrameCount:GibsonCMetal.Circulation1999;99:1945-1950GibsonetalfoundameancorrectedTFC(cTFC)fornormalcoronaryarteriesof213.1frames,yieldinga95%confidenceintervalfornormalflowof(15,27)frames.TheFrameCountReserve(FCR)canbecalculatedbydividingbasalbyhyperaemicTFC.TheFrameCountVelocity(FCV)canbecalculatedbymultiplyingthelengthofthecoronaryarterybytheacquisitionrate(12.5,25,30f/s)anddividingbytheTFC.TIMI计帧TIMIFrameCount:Gibson65TIMI心肌灌注分级TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分级TIMIMyocardialPer66直接PCI后，虽然心外膜冠状动脉血流率高，但再灌注未成功BrenerSJetal.CircCVInterv.2012;5:563-9FarkouhMEetal.CircCVInterv.2013;6:216-23心肌灌注分级TIMI血流ST段回落直接PCI后，虽然心外膜冠状动脉血流率高，但再灌注未成功Br镜下远端栓子和无复流

TIMI3级血流

无微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7镜下远端栓子和无复流

TIMI3级血流无微血管灌注He血栓分级Grade0:Nocine-angiographiccharacteristicsofthrombuspresent.Grade1:Hazy,possiblethrombuspresent.Angiographydemonstratescharacteristicssuchasreducedcontrastdensity,haziness,irregularlesioncontour,orasmoothconvex"meniscus"atthesiteoftotalocclusionsuggestivebutnotdiagnosticofthrombus.Grade2:

Thrombuspresent–smallsize:Definitethrombuswithgreatestdimensionslessthanorequalto1/2vesseldiameter.Grade3:

Thrombuspresent–moderatesize:Definitethrombusbutwithgreatestlineardimensiongreaterthan1/2butlessthan2vesseldiameters.Grade4:Thrombuspresent–largesize:AsinGrade3butwiththelargestdimensiongreaterthanorequalto2vesseldiameters.Grade5:Recenttotalocclusion,caninvolvesomecollateralizationbutusuallydoesnotinvolveextensivecollateralization,tendstohavea“beak”shapeandahazyedgeorappearanceofdistinctthrombus.Grade6:Chronictotalocclusion,usuallyinvolvingextensivecollateralization,tendstohavedistinct,bluntcutoff/edgeandwillgenerallyclotuptothenearestproximalsidebranch.GibsonCMetal.Circulation.2001;103:2550-2554Grade5thrombusGrade4thrombus血栓分级Grade0:Nocine-angiogra69动脉瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

Ectasia–visualassessmentofectasia>1&<1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.Grade2:

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.动脉瘤Alocalizedarterialwideni70病变复杂程度AHATaskForceDefinitionasmodifiedbyEllisetal:TypeA:<10mm,discrete,concentricreadilyaccessible,<45degreeanglesmoothcontour,littleornocalcification,lessthantotallyoccluded,notostial,nomajorsidebranchinvolvement,absenceofthrombus.TypeB1:Oneofthefollowingcharacteristics:TypeB2:Twoormoreofthefollowingcharacteristics:10-20mm,eccentric,moderatetortuosityofproximalsegment,irregularcontour,presenceofanythrombusgrade,moderateorheavycalcification,totalocclusion<3monthsold,ostiallesionorbifurcationlesion.TypeC:≥20mmdiffuse,excessivetortuosityofproximalsegment,totalocclusion>3monthsoldand/orbridgingcollaterals,

inabilitytoprotectmajorsidebranches,ordegeneratedveingraftwithfriablelesions. 病变复杂程度AHATaskForceDefinitio71分叉病变:Medina分型1,1,1分叉病变:Medina分型1,1,172夹层分级

Anintraluminalfillingdefectorflapassociatedwithahazy,ground-glassappearance.Thiscategoryissub-classifiedusingtheNHLBIsystemforgradingdissectiontypes:TypeA:Radiolucentareaswithinthecoronarylumenduringcontrastinjection,withminimalornopersistenceofcontrastafterdyehascleared.TypeB:Paralleltractsordoublelumenseparatedbyaradiolucentareaduringcontrastinjection,withminimalornopersistenceafterdyehascleared.TypeC:Contrastoutsidethecoronarylumen,withpersistenceofcontrastintheareaafterdyehascleared.TypeD:Spiralluminalfillingdefectsfrequentlywithextensivecontraststainingofthevessel.TypeE:Newpersistentfillingdefectsthatmaybecausedbythrombus.TypeF:ThesearenonA–Edissectiontypesthatleadtoimpairedflowortotalocclusionofthecoronaryartery.Dissection-TypeDDissectionflappostPOBAinaheavilycalcifiedlesion-TypeC夹层分级 Anin