冠脉旋磨术适应证选择课件.ppt

1、冠脉冠脉旋磨术适应证的选择旋磨术适应证的选择Rotational AtherectomyDeveloped early 1980s,David Auth PhDduring new device eraUnique operating principle differentialcutting of inelastic(calcified/fibrotic)tissueFall from favour/use late 1990s 1.unfavourable restenosis data(ERBAC,ARTIST)2.regarded as time-consuming to use冠脉冠

2、脉旋磨术适应证的选择旋磨术适应证的选择 为什么要选择冠脉为什么要选择冠脉旋磨术？旋磨术？如何选择适应证？如何选择适应证？冠脉冠脉旋磨术中需要注意的几个问题旋磨术中需要注意的几个问题During past few years,scope of PCI has advanced greatly,including several subsets:Complex,calcified lesions Very elderly patients(10%JGM PCI pts 80yrs)Patients with extensive comorbidity(CRF etc)turned down for

3、 CABG that provide resurgent role for Rotablator in improving procedural outcome.In 2019,55 RA of 462 total PCIs (11.9%)Is there contemporary evidence to support this practice?时代不同了时代不同了Randomisation Of Calcified Coronary Stenoses toTAxus stenting with or without Rotational atherectomy 132 patients

4、at least one moderate-severely calcified lesion on fluoroscopy Rotablation/DES vs DES alone Primary endpoint 8 month binary angiographic restenosis Secondary endpoints procedural success/MACE;acute/subacute/late stent thrombosisROCCSTAR TrialROCCSTAR recruitment to date 113 patients57 Roto/DES56 DES

5、 alone34 large 23 small34 large22 small(3mm or)92%angiographic follow up1.In arriving at 56 pts in DES alone limb,of 64 pts intended for this limb,8(12.5%)unable to predilate fully(placed in ROCCSTAR Rotablator registry)2.Subacute stent thrombosis 2/56(3.6%)in DES alone limb(both in small vessels)vs

6、 0/57 in Roto/DES limbROCCSTAR 2 observations to date reimpact of Rotablation on procedural outcome in calcified lesions冠脉冠脉旋磨术适应证的选择旋磨术适应证的选择 为什么要选择冠脉为什么要选择冠脉旋磨术？旋磨术？如何选择适应证？如何选择适应证？冠脉冠脉旋磨术中需要注意的几个问题旋磨术中需要注意的几个问题Improve procedural outcomeExpand indications of PCI Balloon undilatable or uncrossable

7、lesions,especially with superficial calcification Ostial lesions,particularly aorto-ostial stenosis Bifurcation lesions Long lesions 25 mmFDA的建议的建议冠脉冠脉旋磨术适应证的选择旋磨术适应证的选择 为什么要选择冠脉为什么要选择冠脉旋磨术？旋磨术？如何选择适应证？如何选择适应证？冠脉冠脉旋磨术中需要注意的几个问题旋磨术中需要注意的几个问题指引导管指引导管/磨头兼容性磨头兼容性*an.004”clearance is recommendedBurr/mm i

8、nches Guide1.25.04961.50.05961.75.06972.00.07982.15.08582.25.08992.38.09492.50.09810支架扩张术支架扩张术旋磨支架术旋磨支架术Case 160 yrs,M Smokingfamily historyHypertensionDMnon-Q AMI history mild effort dyspneaSPECT:antero-septal&lateral perfusion defects围手术期抗栓围手术期抗栓 ASA：100 mg/day Clopidogrel：300mg 6 hrs before UFH：7

9、000 I.U.during procedure Eptifibatide:Double bolus followed by infusion during procedure7Fr EBU 3.5PT GW in D1BMW in distal LAD.After predilation,2520&22508 Taxus stents in proximal-middle D1with a residual stenosis at the ostium.Unsuccessful predilation in calcified LADRotational atherectomy(1.75mm

10、 burr)2.7532&3.012 overlapping Taxus stents involving D1 ostium Recross D1 with Pilot 150,but failed in any balloon positioning“Push back”balloon technique:3020 balloon placement in LAD&1515mm balloon placement D1,inflating the bigger balloon pushing at the same time the smaller ballooninto the side

11、 branch using the bigger balloon as supportstep-up predilation&placed a 2512mmTaxus stent at ostium of the sidebranch with a”Vstenting technique Good final resultClopidogrel 75mg was continued for 12 months.No intra or peri-procedural complicationsA low rise of enzyme levels,congruous with rotablator utilization without symptoms and ECG changes in first 24 hrsDischarged after 3 days.冠脉冠脉旋磨术适应证的选择旋磨术适应证的选择 选择冠脉选择冠脉旋磨术旋磨术 选择适应证选择适应证 需要注意的需要注意的6个问题个问题