CTO介入治疗策略的选择课件

CTO介入治疗策略的选择复旦大学附属中山医院心内科上海市心血管病研究所葛雷CTO介入治疗策略的选择复旦大学附属中山医院心内科上海市心DualCatheterAngiographyClearproximalcapGoodDistalTarget3.Length<20mmAntegradeRetrogradeyesnoWireescalationDissectionReentry(crossboss-stingray)WireescalationDissectionReentry(reverseCART)yesyesnonoBrilakisESetal.JACCCardiovascInterv2012TheHybridAlgorithmforCTOPCIinUSACTO介入治疗策略的选择仅仅评价了CTO正向的解剖结构，对侧枝血管的评估不够正向技术和逆向技术的相互转化条件不够细化忽略了平行导引钢丝技术忽略了IVUS在CTOPCI中的作用过分强调了ADR技术DualCatheterAngiographyClearCTO介入治疗策略的选择一百个观众心中就有一百个哈姆雷特，与之相似，不同的术者，就有不同的手术策略……,尽管手术策略多种多样，但仍然有规律可循！CTO介入治疗策略的选择一百个观众心中就有一百个哈姆雷特，与Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235

Case1:Male,47yrsTinystump,healthydistalvessel,length<20mmCTO介入治疗策略的选择060235Case1:Male,47yrsTiCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235Corsair+FielderXTCTO介入治疗策略的选择060235Corsair+FielderXTCTO介060235GaiaFirstCTO介入治疗策略的选择060235GaiaFirstCTO介入治疗策略的选择060235StentingandFinalResultCTO介入治疗策略的选择060235StentingandFinalResul68323Case2:Male,69yrsCTO介入治疗策略的选择68323Case2:Male,69yrsCTO介入68323CTO介入治疗策略的选择68323CTO介入治疗策略的选择683237FEBU3.5CTO介入治疗策略的选择683237FEBU3.5CTO介入治疗策略的选择Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya68323KDL(Crusade)+SionCTO介入治疗策略的选择68323KDL(Crusade)+SionCTO介入68323IVUS(iLab)FrameCTO介入治疗策略的选择68323IVUS(iLab)FrameCTO介入治疗策略68323FrameGAIASecond+130cmFineCrossCTO介入治疗策略的选择68323FrameGAIASecond+130cm68323CTO介入治疗策略的选择68323CTO介入治疗策略的选择68323TipInjection+150cmFineCrossCTO介入治疗策略的选择68323TipInjection+150cmFin68323Sion+150cmFineCrossToughSituation1CTO介入治疗策略的选择68323Sion+150cmFineCrossTou68323Sion+150cmFineCrossCTO介入治疗策略的选择68323Sion+150cmFineCrossCTO68323GAIASecond+150cmFineCrossCTO介入治疗策略的选择68323GAIASecond+150cmFineC68323PositionofRetrogradeWireFrameCTO介入治疗策略的选择68323PositionofRetrogradeWi68323RetroWnotintoAnteGC,eventhroughGuidezillausedToughSituation2GuidezillaCTO介入治疗策略的选择68323RetroWnotintoAnteGC,68323HomemadeSnarewith5Fchildcatheter150cmFineCrossRG3BigloopofSion5FchildcatheterCTO介入治疗策略的选择68323HomemadeSnarewith5Fc68323HomemadeSnarewith5FchildcatheterCTO介入治疗策略的选择68323HomemadeSnarewith5Fc68323Pre-dilationandIVUSCTO介入治疗策略的选择68323Pre-dilationandIVUSCTO介68323abacdebcdeTruetotruelumentrackingCTO介入治疗策略的选择68323abacdebcdeTruetotruelu68323FinalResultsCTO介入治疗策略的选择68323FinalResultsCTO介入治疗策略的选择大连医科大学2015Case3:Male,55,2015-9-8failedtoattemptrecanalizationLADCTO介入治疗策略的选择大连医科大学2015Case3:Male,55,20Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya大连医科大学2015FielderXT-R,GAIASecond+CorsairCTO介入治疗策略的选择大连医科大学2015FielderXT-R,GAIAS大连医科大学2015IpislateralCCtrackingwith150Corsair+SionCTO介入治疗策略的选择大连医科大学2015IpislateralCCtrack大连医科大学2015PingpangTechniqueandReverseCARTwith2.5mmballoon(A:GAIAFirst;R:

GAIASecond)CTO介入治疗策略的选择大连医科大学2015PingpangTechniquea大连医科大学2015PingpangTechniqueandExternalizaitionwithRG3CTO介入治疗策略的选择大连医科大学2015PingpangTechniquea大连医科大学2015FinalResultsCTO介入治疗策略的选择大连医科大学2015FinalResultsCTO介入治疗56439Case

4:Male,48yrs,2015-3-10D1stented(misrecognitionforLAD)CTO介入治疗策略的选择PrimaryRetro:

Nostump,Stentstruts,PromisingCC56439Case4:Male,48yrs,201Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya56439150Finecross+SionCTO介入治疗策略的选择56439150Finecross+SionCTO介入56439150Finecross+FielderXTCTO介入治疗策略的选择56439150Finecross+FielderX56439ModifiedReverseCART+GAIASecond,SionCTO介入治疗策略的选择56439ModifiedReverseCART+G56439ModifiedReverseCART+Sion,SionnotintoAnteGCCTO介入治疗策略的选择56439ModifiedReverseCART+S56439GuidezillaCTO介入治疗策略的选择56439GuidezillaCTO介入治疗策略的选择56439FinecrosschangedtoCorsair,externalizationwithRG3CTO介入治疗策略的选择56439FinecrosschangedtoCors56439FinalResultsCTO介入治疗策略的选择56439FinalResultsCTO介入治疗策略的选择广西南宁2015CASE5：Male,58yrs,IDDM,LVEF60%,FirstattemptfailedCTO介入治疗策略的选择广西南宁2015CASE5：Male,58yrs,I广西南宁2015CTO介入治疗策略的选择广西南宁2015CTO介入治疗策略的选择广西南宁2015R:6FSALL:7FEBU3.75CTO介入治疗策略的选择J-CTOScore2:Stump,length＜20mm,re-trycase广西南宁2015R:6FSALCTO介入治疗策略的选择JCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya广西南宁2015130cmFineCross+FielderXT-RCTO介入治疗策略的选择广西南宁2015130cmFineCross+Fiel广西南宁2015150cmFineCross+Sion,AVGrooveChannelinjuredCTO介入治疗策略的选择广西南宁2015150cmFineCross+SionCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya广西南宁2015ParallelWiringwithGAIAFirstCTO介入治疗策略的选择J-CTOScore3:WithoutStump,length＜20mm,re-trycase广西南宁2015ParallelWiringwithG广西南宁2015SionintoRCA-PLCTO介入治疗策略的选择广西南宁2015SionintoRCA-PLCTO介入治广西南宁2015FinalResultsCTO介入治疗策略的选择广西南宁2015FinalResultsCTO介入治疗策略广西南宁2015CASE6：Male,55yrs,OMIR:AL0.75SHL:

7FEBU3.5SHCTO介入治疗策略的选择J-CTOScore1:length＞20mm广西南宁2015CASE6：Male,55yrs,OCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya广西南宁2015Balloonanchoring+Parallelwiring(FielderXT-R,GAIAFirst)CTO介入治疗策略的选择J-CTOScore3:length＞20mm,calcification,bending＞45degrees广西南宁2015Balloonanchoring+PaCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya广西南宁2015150Corsair+SionCTO介入治疗策略的选择广西南宁2015150Corsair+SionCTO介广西南宁2015Knucklewiring(FielderXT,ConquestPro)CTO介入治疗策略的选择广西南宁2015Knucklewiring(Fielde广西南宁2015PreparingforReverseCARTwithGAIAFirstCTO介入治疗策略的选择广西南宁2015PreparingforReverse广西南宁2015GAIAFirstintothetruelumenCTO介入治疗策略的选择广西南宁2015GAIAFirstintothetr广西南宁2015FinalResultsCTO介入治疗策略的选择广西南宁2015FinalResultsCTO介入治疗策略61887Case7.Male,60yrsoldCTO介入治疗策略的选择61887Case7.Male,60yrsoldC618877FEBU3.5SH6FSAL1.0SHCTO介入治疗策略的选择618877FEBU3.5SHCTO介入治疗策略的选择Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya61887CrossBoss,FielderXT,Ultimatebros3CTO介入治疗策略的选择61887CrossBoss,FielderXT,Ul61887FinalresultsCTO介入治疗策略的选择61887FinalresultsCTO介入治疗策略的选择Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvessel