个iros congress这是由Incathlab进行现场直播

113秒-120

IROS…livestreambroadcastbythe‘in这是由Incathlab公司进行的现场121秒-127SowewillhavethissessionnowinEnglish.因此，我们现在将用英语进行。128秒-145秒Imayremindyouthatafterthislivestream,this ‘incathlab’willcutandeditthesessionanditshouldbeavailableontheInternet.我在这里提醒大家：现场后，Incathlab公司将对进行剪辑，大家可146秒-149Theytoldmefewhoursorfewminutes151秒-23Ithinkwewillgointothisinterestingprogramwhichhasthetitle“abovethekneesnewadvancesintechniquesthatimprovethe 24秒-210Thereareinterestingpresentationsandtwocaseswhichwillbe211秒-230Myco-moderatorisDr.FussfromGermany.AndIthinkwewillstarttogointothefirstpresentation.Andthisiswhatmattersforoptimized esinthischallenginganatomy.我的合作仲裁者是来自德国的Fuss博士。我认为开始第一个展示，就是在这个富有的解剖区域，什么对于优化结果重要呢？231秒-236AndDr.HoffmannfromSwitzerlandwillgivethepresentation,有请来自的Hoffmann博士给我们做汇报演示237秒-45ItgotmeprettyawkwardtospeakEnglish,toapurelyGermanyspokenaudience.Well,tryingtodothat.246秒-51Abovethekneechallenges:whatmattersfor esinthischallenging膝盖之上的：在这个富有的解剖区域，什么对于优化结果重要呢253秒-33Well,I’mprettygoodatthepessimisticside.SoI’mgonnabetakenthepositionofcurbingyour34秒-316That’saboutwhatwecanactuallyistoachievekindalikecautionyouwhatwedotoday,andwhereweactuallydothingsthatarenotcorrectiveandprobablydisadvantagesintermsofachievinggood 就是关于我们实际上能做的也就是做到我们现在正谨慎做的事情事实上我们在做着不317秒-327I’llleavetoZech,FunovicandKickuthtobemorethantheoptimisticsideandlyou‘hey,thisiswhatwedoandthisishowweactuallyoptimizetheir 328秒-345Let’sstartwiththeverybasicfactsthatSFAisunique,andherewhatweareaddressinghereisavesselrelevantaboutmuscle.Anditisaverychallengingterritory.这是一个非常具有性的领域。346秒-349It’sprobablymorechallengingthanthecoronarysystem.It’sprobablyevenmorechallengingthanthecarotidartery.它可能比冠状动脉系统更加具有性。甚至可能比颈动脉更具有性350秒-43Andwehavetoaddressthatwiththeoptimaldeploymentstrategy,andwecertainlydohavetheoptimaltooloutofourtoolboxwhichishugebynow.44秒-410Andactuallyit’sprettyconfusingforthenoviceandtheinterventionisttoreallypicktheright411秒-416AndtheSFAischallenging,whyisitsochallenging,becauseitisrelevantaboutmuscleandthemuscleismovingat….SFA非常具有性，为什么这样具有性呢？因为它与肌肉相关，肌肉…移动417秒-426Thereisnotonlyextension,contractioninthatvessel,butthereisalsoadistort,thereisflexion,thereiscompression.那根血管不仅可以伸展，收缩，而且也有一种的力量，哪里有弯曲，哪里就有压缩427秒-435Andallofthisoccursduringourwalking,running,whatsoeversitting436秒-442Anditstandsthatwe’llsurviveinthatsituationwherewearereallyhavetogowithallthose443秒-459Intermsofourdailybusiness,shouldwebedtoreallydoaformativejacketreallycoverthewholelengthoftheSFAstent,eventhoughlatestcuttingedgearegonnafail?SFA支架的全长。500秒-520Andthisiswhatweactuallyexperiencehere.Manymanyofourpatientswhenweoverdothingsliketheystandtolong,wedoseefractures,wedoseedistortpartsofthestentgraft.Thisisreallynotwaytogo.521秒-523Theoptimaldevelopment524秒-541Well,ifyoulookatthepapersthatareoutthere.Thereisonefullmetaljacketpaperofthesuperficialfemoralartery,aretrospectivereviewmostlydonenotbyinterventionalradiologistsbutbyourfriendsfromvascularsurgery.如果我们看一下这些已经的文献，其中有一篇关于浅表股动脉的金属外壳的文献，一个542秒-549秒Andtheyputintheirmaterialandmethodsectionsomethinglikethestentswerethenironedtothevesselwallbypost-dilatation.550秒-614…Well,ifyoutreatyourstentlikea that’sprobablynottherightwaytodoit.AndI…kindoflikecautionyoutodoitthatwaybecausethisisproducinga6-monthpatencyrateofwhichwassoverydismalcomparedtoopensurgery,thatyoushouldn’treallygothat如果你像..对待你的支架，那可能不是正确的方式。提醒你谨慎处理它。因为它6个月55%，这与开放手术相比结果令人堪忧，你真的不应该采取那种方式。615秒-634Anotherexperience,thattomeallyoccursmaybelikeeighttotenyearsago,wewerealwayspickingreallybigstents,wehadaunanimoussizeofsomethinglike7,8,9millimetersfortheSFAandwejustdeploythoseself-expansiblestents.8-10年前，我们总是想选择更大的支架。我们7，8，9SFA的尺寸，我们刚刚放置了一个自我膨胀的支架。635秒-652秒Thosepatientsreturnedacoupleofmonthslater.Andacoupleofmonthslateritlookslikethis:wehadaverynarrowed,thinlumentheresurroundtheintimalhypersia.Supposedlyintimalhypersia,Idon’tknow.…653秒-73…Andthestentseemstobeactuallywonderingthroughthevesselwalllayerstotheevenbeyondthat.74秒-709

orThisissomethingthatyouseeifyouoversizedramatically.Westilldooversize这就是你看到的尺寸所产生的结果。我们仍然在做尺寸的事情710秒-718WhydoIbeabletostatethat?BecausethereissomeinventoriesdonebyAbbott719秒725Lookingatwhatisthereferencevesselsizeduringtheirstudies,prospective726秒-731AndthereferencevesselsizeoftheSFAisintheballparkoffivemillimetersusually.SFA5毫米范围内。732秒-744Ifreallymeasuredwithagoodcalibrationmethod，nowthestentfortheSFAbeingpickedoutoftheshelffromtheirstockismostlyundersize,sevenmillimeters.SFA支架来说尺寸不够，7毫米。745秒-747Sothereisoversizingatleasttwo因此，至少有两毫米的尺寸748秒-752Idon’tknowtwentythirtyfortypercentofoversizing.我不知道究竟是20%，30%还是40%的尺寸。753秒-754秒Thisissomethingthatweprobablyshouldnot755秒-800Ireallypicktheappropriatesizestentfortheappropriatesize801秒-805WedoseealotofpresentationsconcerninghowdoIdo我们确实看见很多关于这方面如何做的806秒-817AndoneofthesepresentationsbyAminoattheLINC2013forthedrugelutingballoontechnologystatedthathehasalwayspre-dilated,ngpre-dilatation.其中有一篇是Amino在LINC2013上做的有关药物涂层球囊技术介绍总是在进行预扩张817秒-826Andheistryingtofindthepre-dilatationtothevesselsegmentthatwilllaterthenbeingcoveredbythedrug-coatedballoon.827秒-831Nevertheless,pre-dilatation,thisiswhathe mends832秒-837Thisiswhat mendedforallthesestentdeploymentstrategieswiththeSuperastentSuperaII838秒-854NowwhatwearewewantistoachieveifwestenttheSFA.Wewanttocoverthelesionwewanttocoveritwithastentthatpushesoutward.ThisiscausingsomechronicoutwardfortheSFA855秒-906Sothat’scenterlumennarrowingwereallywantIhavesomechronicoutwardpushingtowardstheque.907秒-926Butassoonaswereachthenominaldiameter,wedon’twantchronicoutwardanymore.Becausethischronicoutwardprobablyinducingintimalhypersiaresponsevesselwallandit’sprobablythecausingagentforthemostofournewintimalhypersiastenosis927秒-949IfwelookattheSuperastent,thereisverymeticulousdescription,thereisatableherethatlsyouhavetopre-dilateyourvesselsegmentwith6millimetersifyouwanttodeploya5millimetersstent,ifyouwanttodeploymenta6millimetersstentyoureallyhavetoover-dilatealmosttosevenmillimetersinordertobeabletodeploythatstent.Supera支架的话，它有明确的详细描述。那里有一个表格告诉你如果你想7950秒-1001ThisprobablywhatexinswhytheSuperainitsoneyearpatencyratesisperformedbetterthantheotherstents,theself-expandablestents.Supera1002秒-1014Thereisanothercriticalissue.Aself-expandablestentliketheAbbottAbsoluteorlikethe…stentsdoeshaveachronicoutwardinordertostayince.1015秒-1027Ifwereallypickedtherightsizethenitwillstaythere,ifwepickonethatisnotcausingtoomuchchronicoutward,wearenotinducingtoomuchnewintimalhypersia.AndtheoutwardofSuperastentiszero.如果我们选择一个不会引起太多外向推力的支架，不会诱导新生内膜增厚。0。1028秒-1040Ifwewanttodeployit,hasreacheditsnominaldiameter,thereiszerooutward.Thatisprobablywhatisminimizingnewintimalhypersiaresponse.1041秒-1101Likewise,ifyouusedastentgraftyouprobablycanexcludenewintimalhypersiainthatlengthofthelumen,butyouinducenewintimalhypersiaattheedges,andthisiswhatcausesyouredgestenosisproblemandtheyfoundintheVAPERtrialifyouoversize,thereisalotVAPER实验中发现，只要你尺寸选择，就会有的狭窄。112秒-1118Theoptimaldeviceoutofthetoolbox.Well,whynotsurgery?Whynotbypassgrafting?It’sveryinterestingtoseecomparingthetrials,Ipickedonethatisreallygoesintothelongtermpatency现象，我选择了一个研究长期支架畅通率的实验拿来。1119秒-1129AndthatshowsyouthatbothareperformingthesameareathisisastudydonebyvascularsurgerygroupinnewEngland,andtheyfoundcomparing140bypassgraftstoalmost200stentsintheSFA.140例搭桥和将近SFA1130秒-1157Theyfoundcomparableprimarypatencyratesandverycomparableassistedprimarypatencyatfouryears,sothestentisnotthatbadasitisprobablyconsiderbytheArmadaofdrug-coatedballoonusers.Armada1159秒-1211WorseresultsoccurinlongerlengthSFAlesions.Thisissomethingthatwehavetoconsiderassoonaswegoforlongerlengthlesions,theself-expandablestentisprobablynotthewaytogo.SFA1212秒-1221Let’strytosummarize.neoldballoonangiostyisprovidingis40-60%patencyrateat1year.Thisisnotadequate.…让我们做下总结，POBA40-60%，这一结果并不足够。1222秒-1231秒…Thisiscanbeusedifyouhaveawearetryingtoachieve.

results,butinthelongtermsshouldbeconsideredreally1231秒-1239Patencyratesofself-expandablestentsgointotheballparkofsixty-fivetoeighty-fivepercentoneyear,notthat1240秒-1249秒Andthiscanbehopefullyimprovedforalongerlengthlesionbecauserepeatedlydeclineforthoseifyouuse对于较长长度的病变这一情况有望改善，因为如果你使用…1250秒-1301Thedrugcoatedstentdoesprovidesomerestenosisprotectionfortheinitialtimeframeofoneyearprobablyoneandhalfayears.1301秒-1312Butnotbeyondofthat,andthepatencyrateofdrugcoatedballooniscertainlybetterthantheneoldballoonangiostyanditistrulybetterthanaself-expandablewedon’tknow.1313秒-1324Wearereallylookingforsomethingthatwillbethereonlytemporarytoscaffoldourdiseasevessel,andthatisinthemakingrightnow.1325秒-1332Deploymentatorclosetonominalstentdiameteriskeytosuccess.Donotoversize,preparethevesselwithPre-Dilatation.1333秒-1348Andcertainlythefullmetaljacketisnotreallydoableatthecurrentpointoftime.Itcanbeusedforatemporaryvesselopeningifyouhaveastage-fourdisease.1349秒-1402neoldballoonangiostywithspot-stentingisprobablythemostreasonablestrategyrightnow.Longlesionsareprobablybettercoveredstentortreatedbysuperastent.POBASupera支1402秒-1404AndtemporaryScaffoldingisreallyonourwishlist.Thank临时支架已经列入我们的期待中。谢1413秒-1437Thankyouverymuch.Ithinkwewilldiscussattheendofthesession.Therefore,wewill…ontothefirstcasepresentation. pre-dilatationisabsoluyessential.Absolutecase…theUniversitatssptalBasel.AnditwillbepresentedbyMr.Zech博士呈现。1439秒-1446FirstIwanttointroducemypartnerwhichisMartinTakes,whichwillassistme.Andinthecase,mynameisChristophZech.首先要介绍下我的搭档，MartinTakes，接下来他将辅助我完成操作，在这个病例里，ChristophZech。1447秒-1456We’refacingapatientwitharightSFAocclusionfromultrasoundfindingweknowitisabout20centimeterslong.超声结果显示这是一个右侧SFA阻塞的，我们了解到病变大概是20厘米长1457秒-1459Thepatientis64yearsoldmalepatient.是一名64岁的老年患者。1500秒-1508秒HeisclaudicationstageIIb(Fontaine)withwalkingdistance50meters.It’slifestylelimitingforIIb501509秒-1516Forcardiovascularriskfactors,heisasmoker.He’shypertensionundertreatmentdyslipidaemiaunder对于心血管来说，他吸烟，有高血压和血脂异常，目前正在接受治疗1517秒-1531Primarymedicalhistoryisvaricosis.Medicaldedicationisaspirin,valsartan,amlodipine,andatorvastatin.Sotreatmentofhypertensionanddyslipidaemia.1532秒-1537Sofromultrasoundweknowthatitisaveryproximal1538秒-1550Weexpectonly1or2centimetersleftoftheSFA.Stillourfirstapproachistodoantegradepuncture,althoughweknowthatmightbedifficult.我们预期是一个1cm或2cm的SFA。尽管知道这种操作可能很，我们首先选择的仍然1551秒-1558Ifweencounterdifficultyanditreallyisthe如果我们遇到，真的行不通的话，1559秒-1627秒

there,wewouldthenmovetocrossover……Fromhisbody…,thisisalsomightbeexpectedtobealittlebithard.Nevertheless,thereforewefirstgoprocedurewitha35-inchtformfirst,andwewillneeda6FrenchsheathtodoballoonangiostylaterwithArmadaballoon.Wemostlikelywillneedastent.WewanttochooseAbsoluteProstent.从他的身体…35英寸的平台进行操作，需要一个6F的鞘管，然后用Armada球囊进行球囊成形术，我们可能需AbsolutePro支架。1628秒-1636Accordingtotheultrasoundmeasurements,wemaybeneedtwostentsandwithexpectedsizeofsixorsevenmillimeters.6-7mm1637秒-1640TheclosurewillafterwardsbedonewithStarclose随后用Starclose装置进行关闭操作1641秒-1642秒That’sit.Wegoforthecase.1647秒-1710秒Sointhiscasewestartedwithantegradeapproach,butitwasnotsuccessfulduetohisocclusionoftheSFAclosetothebifurcationandthereisalotoftissueonthewaytothevessel.Soweswitchtocrossoverprocedure.1711秒-1714Soweseeaquitehigh1728秒-1741Sincethelongsheathhasnotcompleyinside,heisaquitetallpatient.Wehavetoexchangeforalittlebitlonger,…,sowechoosea5Frenchnow.的，…5F鞘管。1743秒-1746Weforthefirsttimetakealookatthe1747秒-1757Ok,herewegotoseetherefilloftheSFAandsmallandslowfluidflowing,butpatentandotherwisefinepoplitealartery.1759秒-1810Ithinkfromthe wecanappreciatewhywehaddifficultyinenteringfromalthoughsometimesitis尽管有时是可能的，我们现在可以明白为什么顺行进入存在啦1811秒-1818Andifitispossible，thenthisofcourseisveryhelpfulforthe1819秒-1830Butactuallytheexpectedzoneofthreecentimetersangiographiclyisnotquitein1832秒-1836Canseenowtheslightoverlad,justhelpfultogetintotheright.现在我们可以看见有轻微的，可以帮助我们进入右侧。1837秒-1849秒YouseeactuallytheultrasoundisnotsowronginclaimingthreecentimetersofSFAleftwhichwedidnotseeduetoover-projectiononthepreviousimage.SFA1851秒-1900Nohighmagnificationtoreallyseehowthewiregoingon.Wedohavethebestimage1912秒-1922Soactuallyintheultrasoundreporttherewasabigcollalvesseldescribedwhichwenowseeveryclearly.因此超声的有一个大的侧枝循环血管，现在我们很清楚的看见1923秒-1931It’sthereasonwhythewirewasadvancinginthatway.Actuallyitseemsthatwearealittlebitfurtherdownbutit’salready.1936秒-1949Nowadvancetheguidecatheterjustalittle,probablywehavetoswitchtoballooncatheterafterwards.Ok,itlooksquitegood.1950秒-2003…Thewireisadvancingveryfast,thereisanannoyingintherightlumennow.Thatlooksgood.…

onthe

sowecan’tseewhetherit……2004秒-2014Andthesmallrealmofcalcificationthatlooksverypromising.Actuallythemostpromisingsignishowthewiremoves.……2019秒-2035……Ok

verygently.It’smaybeoneofthe

Thereisalreadysome好啦，轻轻地，可能是一个。…已经有一些血流了2036秒-2043Asexpectednotsufficient.Weshouldreallykeepthatopen,butIthinkitlooksnot2053秒-2107FromtheultrasoundweknowthattheproximalSFAhad7-millimeterindiameter,andalmost6.6,so7-millimeterstentproximallywillbefine.SFA76.67毫米的支架将是可以选2111秒-2119Nowwehavetomeasurewhetherwehavelongenoughstentorwegowithtwostentsandthedistalonewithlessdiameter.现在须测量是否我们有足够长的支架或我们可以选择两个支架远段放置较短直径的2121秒-2129Sothedistanceistwenty-twocentimetersandwewillusetwoAbsolutePro距离是22cm，使用两个AbsolutePro支架2131秒-2146Thisisourstent.AndasImentionedwehave releasesystemwhichgivesus,ascanseeherefromthatpoint,nomovementwhenreleaseitwhichisverynicefor2152秒-2158Crossthelesiononcetotallyandthenpullitlittle222秒-2208Seehowitopensexactlywherewewanttohaveit.Itdidn’t2218秒-2224Sotheproximalstentwechoosetheseven-millimeterdiameterand10-centimeterin7102226秒-2229Afterthiswe’llpost-dilatewithfive52241秒-2246Wecanseehownicelythesystem2249秒-2300SowenowtaketheArmada35balloontopost-dilatatewechoosealengthof20Armada35202303秒-2314Thedifficultareaisquitewell,wenowlookingatthe,rightnowalittlebit,OK,thatlooks2325秒-2329Ihaveatrynottogooutofthestented2335秒-2439Maybewecangothroughtheimagesagain.Wearequitehappywiththefoot…2340秒-2359…didn’thaveanylesions,soverylifestylelimitingclaudicationwasindicationweseebelow…kneevesselsquitewellasImentionedpreviouslyandthe ,wehavegood…2400秒-2407DuetothatsituationtheSFAispatentnow,theareawherewecedthestentlooksSFA249秒-2413I’mhappywiththis.Ittookalittlelongerthanweexpecteditto2415秒-2424Butthelesionwasreallyquitedifficulttopass,especiallyatthebeginning,becausetherewasthemutualcolla lwhichwaspassingtoright.2425秒-2429Sowewillalwaysenterthis lbutnow,theresultisvery2439秒-2454Lettingusdiscussitalsolateror.Iwouldliketodiscussthiscasejustnow.Ithinkitwasverywelldoneofcourseandyourecizedthisdifficultandchallenginglesion且富有性的病变再通2455秒-2510ButifyoufollowthepresentationofDr.Hoffmann,youshouldhavedonevesselpreparationintermsofpre-dilatationwiththeballoonwithsomekindofoversizing.Hoffmann医生的讲演内容，你应该通过球囊预扩张来对血管进行预处理，已达2410秒-2523Youhavedoneamoreorlessveryconventionaltechnique,ngsomesmallballoonpre-dilatation,thencedthestent,thendidballoondilatationwithinthestent.2423秒-2537SoafterhavingheardthepresentationofDr.Hoffmann,wouldyouchangeyourtechniqueinthefuture,woulddovesselpreparationintermsofalittledilatationbeforeyoucethestent.Hoffmann医生的讲演后，你会在将来改变你的技术吗？会不会在放置支架前2538秒-2542Actually，Idon’tknowwhetheritisnecessarytogoforit2543秒-2555YouarerightthatifIcoulddoitrightnowagain,Iwould’verathertakeafiveorevensixmillimetersballoonforafterwardscing,thenthesixmillimetersstent.2556秒-2609Butifyoulookwhatisdoneoutinthefield,alotofpeople,Ithinkwhatisreallyimportantpointisthatyoucreateachannelandreallymakespaceforthestent.2610秒-2615It’smaybeoneortwomillimetersmore,it’sunderdiscussionhowmuchinfluenceithasonthe122616秒-2627Thereisalwaysabitofdiscussionthatwithregardtododistalembolizationtodotheprimarystentingwithoutanypreparation.Ithinkthatitisreallynotaverygoodidea.2628秒-2646Youshouldnotdothat.Ithinkthiskindofdilatationisquiteimportant,butinhowfar,howmuchpercentyouwillneedfortheactualstentintheend.Itisstillunclear.2647秒-2651Iwouldgoforalittlebitslighter,higherballoon2652秒-2656DrHoffmannoncegivesacommentandthenwemoveon.Hoffmann医生一下看法，然后我们进行下一个环节2657秒-2701秒Ifyoupre-dilatatedthatsegmentwhichisprettylong,Idon’tknowhowlongit2702秒-2710Youprobablyendedupinablockstentingofthatsub-intimalrecizationlengthandtherestwould’vebeenjustcoveredbytheballoon.2712秒-2724Althoughmaybeseveralexpertssawonlyonestepofdilatationhere,wedidthatfor2minutesanddidanotherfor2minuters,sowediditforalongertimeforsure.2725秒-2733ImeanIchangedmycurrentpracticetotallybyjustonlyngpre-dilatationforalltheseThey’reneverpost-2734秒-2738Putthestentinandthenpost-dilatateitisnolongerourcurrent2740秒-2754Ok,thankyouverymuch.Ithinkwemoveon.Ok,We’recomingtotheothertalk:Thetopic‘Absoluyright–trials es’PleaseProfessorFunovicfrom y正确——研究和结局，有请维也纳的Funovic教授2756秒-2758秒Chairmenladiesandgentlemen好，们先生们2758秒-282You’venowYou’venowseenhowto ntthedevices283秒-2810NowletusseeinanoptimisticstandofpointasDr.HoffmannpointedouthowlongtheywillHoffmann2811秒-2820IfwetakealookatthelandmarksofstudiesconcerningtheSFAstenting,andplotthelesionlengthoverthetwelvemonthsofprimarypatency.SFA12个月的初始通畅率进行2821秒-2827Wedoseeatransferdecreasepatencyinafteroneyearinthelonger2828秒-2836Andwithinthedifferentstudygroupsstillalargescatter.Andthere’sno 2837秒-2846Howpre-dilatationshouldbeperformed?Howstentselectionshouldbeperformedespeciallyinfractureresistantceandoversizing.2848秒-2858Sothetwodesign-inherentfactorsI’mgoingtofocusinthistalkisfracturecausingtheendothelialtraumaatthesiteofthefracturethatleadingtoearlyrestenosis.2859秒-299Andoversizingthatpotentiallyviaexcessiveradialtochronicirritationoftheintimalofthesmoothmusclelayer.Andagainitleadstoearlyrestenosis.2910秒-2928Itisnowwellestablishedthatthestentfracturesendadirectcontacttotheendothelialleadtorecruitmentofcellularmediatorsandmigratorymovedmusclecells,buildingupanewintimal,andleadingtothosewell-known eswithhighgradestenosisofthesiteofthe2929秒-2945Stentfractures,however,are inglessofaproblemwithmoremodernstentdesigns,withpolishsurfaces,withinactivatedsurfaces,andwiththebetterdesignsofbreachingstentsconnectingtheseparatestentrea.2946秒-2956Youseethatveryrecentstudiesshowstentfracturerateisabout2%comparedtoearlystentfracturerateoftwentytothirtypercent(20-30%)intheearlylandmarkstudies2958秒-3012秒Sowhatremainstobedesign-inherentandprobablyoperatordependentinthechoiceofthestentdesignandsize.It’sthefactofradialcausingpotentiallyearlyrestenosis.3013秒-3024Thisisatypicallyimageofstentthatisoversizedmigratesintothevesselwallovertimeanddoescausearestenosisoverthefulllengthofthestentsegment.这是一张尺寸过大的支架随时间推移迁移入血管壁并引起支架全长再狭窄的典型3025秒-3032Butlookhowmuchbiggerthestentisinrespecttotheoriginalvessel3034秒-3042Weknowthereisaconnectionwithsevereoversizingindiverseanimalmodel3043秒-3100Inthisstudy,forexample,theyinsertedstentsiniliacarteriesofswinecouldshowhereistheblotofthestent-to-arterydiameterratiowithsevereoversizingwithstentsizesuptotwicethearterysize.3101秒-3111Thereisdefiniywellestablishedcorrelationatsixmonthsfollowupbetweenrestenosisandoversizing.Thesearethecorrespondinghistologicalimages.6个月时，再狭窄和尺寸过大有很明确的相关性，这是相关的组织学改变3113秒-3122Moderayorhardlyoversizedstentleadstoaverymoderatedepositionofnewintimainsidethestentstruts.3123秒-3133Anaveragelyoversizedstentleadstocorrespondinglyhigherbuildingupofnewintimalformationintheinternalelasticlamina.3133秒-3144What’sinsidetheinternalelasticlaminaisnewlybuiltupnewintima.What’soutsidetheelasticlaminamightbeactivestentmigrationintothevesselwallandthesurroundingtissue.3145秒-3154Andveryclearisthefactthatextremelyoversizing,howeverthisishardlyokinhumanstudywhenthestentistwicethesizeofthevessel.3155秒-3204Thereisanotherproblemandthismighthelpusalittlebitindeterminingwhetheroptimalvesselpreparationisnecessaryormandatory.3205秒-3218Wedohavedifferentchronicoutwardifthestentinsomeregionsofthelesionisnotallowedtoexpansetoitsfulldiameterwhichisoftenthecaseinseverestenosisorheavilycalcifiedlesions.3219秒-3236Here,apropervesselpreparationmighthelpinsmoothingoutthoseareasofveryhighchronicoutwardwheresignificantrestenosisispresent.There’sanotherthingthatchangesthe3236秒-3247ProfessorHoffmannhasnicelypointedout.Howmanyinfluencesfromtheoutsidetortureourstentandduringthemovementandthemuscleactivation,thestentcanbecompressedtoextremesizes.Hoffmann教授已经为我们。在运动过程中以及肌肉激活过程中，外部支架会造3248秒-3303Theseare6-millimeterstentsinsertedin5-millimeterartery.Butlookhowhighthegradeofcompressionisatsomepointduringflexure,anditcaneasilygodownto50%ofthenominalstentdiameter.3305秒-3316Nowweknowthatthereisalsoamaterialcomesintoy.Itisnottheamountofoversizingalonethatdeterminesthechronicoutward.3317秒-3331Becauseifplotcompressionbelowthenominalsizeovertheactuallyexertedchronicoutwardinnewton,youseesomestentshaveaflatcurvebecausetheyarespringconstant.3332秒-3341Thesteepnessofthecompressioncurveislower.Andotherstentshaveaninitiallyhigh,thenaflatpartofthecurve.3341秒-3352Andtheniftheyarecompressedincaseof6-millimeterstentbelowtothirdoftheoriginaldiameter,theovercompressioncurve esverysteep.63352秒-3401Somistakesinsizingthatbringuswiththesestentfabricateintothesteepareaofthecurvecanleadtoextremelyhighchronicoutwardinsomeces.3402秒-3332…Anditmightbepreferring…,especiallywhenweenterthepoplitealartery …femoralartery,touseastentwithaflatexpansioncurvethatgivesusmoresafetytonotexertoverlyexcessivechronicoutwardinsituationswherecompressionisexertedbeyond5millimetersthatweoriginallywantthestenttobecompressed.5毫米时，产生过大的慢性外推力3434秒-3452WhatwehavelearnedfromtheVIPERstudyisthatattimeswherefivemillimetersstentswerenotavailableandsix-millimeterstentgraftsinthisstudyhavebeenimntedeveninfemoralarteriesoffourorfivemillimetersin63453秒-3506Thatitwasthosearteriesthatledtoanexcessivenewintimalformationattherespectiveinflowandoutflowedgesofthestentgraft.Logically,theycannotgetrestenosisoverthefulllength.3507秒-3516ButifwedividetheVIPERpatientsintothosethathavebeenoversizedbutlessthan20percent,weseeamuchbetterpatency.3517秒-3528Heretheblackcurveatoneyear,ninety-onepercentprimarypatency.Asopposetothosethathavebeenoversizedbymorethan20percentwhereasthepatencyatoneyearisonlyseventy70%3530秒-3554SoanotherstudythathasbeenpresentedbyDr.SchroefromBelgian,CIRSE2011,observedabout100patientswithameanstenosislengthofaboutsixcentimeters,andabout20%occlusionand80%stenosisintheSFA.Andthisstudyhasaverylongfollow-up.20%80%的狭窄。且随访时间很长。3556秒-3512SoDr.SchroereportedthatheonlyuseAbsolutestentwithaveryflatexpansioncurve.Veryencouragingprimarypatencyresultsare87%atoneyearand71%primarypatencyatfiveyears.87%，571%。3613秒-22Andifwelook,takeanotherlookatthecurve,allthatIpresentedatthebeginningofthestudy,thisputshiminthetopfield..3622秒-33And,onereasonmightalsobethatthereisaconnectionbetweentheflatexpansioncurveandtheavoidanceofexcessivechronicoutwardinobtaininggoodresults.3633秒-46SoweinViennadidaretrospectivestudytodetermineifthereisreallyanactualbetweenoversizingand3647秒-51Thiswasaretrospectivedatamining3651秒-3710Andwetookpatientsoutofstudieswheretheone-yearfollow-uphasbeenscheduledandthepatientwassupposedtoshowupindependentofoccurrenceofanysymptomsforhisone-yearfollow-upeitherwithultrasound,CTAorMRA,orarepeatedangiography.3710秒-Weyzedthestentdiameterandotherco-variablesandputitintotheconnectionwiththenominalstentsizeintocorrelationwiththehealthyvesseldiametertodeterminetheamountof3726秒-36And,weonlyusedthoseveryreliablemeasurementcouldbemadewitharulerorsomeothercalibrationdeviceincetheangiographyimages.我们只采用尺或其校准装置等非常可靠的测量方式对血管造影的图像进3736秒-56Soifwetakealook,wehavealreadyincluded30patientspredominantlymale,andwehavet