1、1959年Mason Sones 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1950s1960s1970sRyan Circulation 2002,106:752-7561980s1990sRyan Circulation 2002,106:752-7562013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桡动脉桡动脉掌浅弓掌浅弓尺动脉尺动脉Barbeau.G et al;Am Heart J 2004;147:489932 minBarbeau.G et
2、al;Am Heart J 2004;147:48993NOJudkinsAmplatzTiger 导管导管JR4 导管导管左主干左主干(LM)左前降支左前降支(LAD)对角支对角支(D1,D2)间隔支间隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM Radiographics 2007;27:1569-1582Radiographics 2007;27:1569-1582Marginal branchConus branchMarginal branch回旋支回旋支(Cx)钝缘支钝缘支(OM1,OM2)OM1CXOM2LAD Radiographics 20
3、07;27:1569-1582OMOMLMSCXCXOMRadiographics 2007;27:1569-1582IMCXLMS后侧支(PL)后降支(PD)左主干起源于右冠窦radiologyassistant.nl/en/48275120e2ed5Myocardial bridge in LADradiologyassistant.nl/en/48275120e2ed5A myocardial bridge occurs when one of the coronary arteries tunnels through the myocardium rather than resting
4、 on top of the myocardium钙化1234BifurcationOstialTFG0TFG1TFG2TFG3Gibson C M et al.Circulation 1999;99:1945-1950Gibson et al found a mean corrected TFC(cTFC)for normal coronary arteries of 21 3.1 frames,yielding a 95%confidence interval for normal flow of(15,27)frames.The Frame Count Reserve(FCR)can b
5、e calculated by dividing basal by hyperaemic TFC.The Frame Count Velocity(FCV)can be calculated by multiplying the length of the coronary artery by the acquisition rate(12.5,25,30 f/s)and dividing by the TFC.Gibson et al.Circulation 2000;101:125-13027|MDT ConfidentialUC201204429EEBrener SJ et al.Cir
6、c CV Interv.2012;5:563-9Farkouh ME et al.Circ CV Interv.2013;6:216-23心肌灌注分级TIMI血流ST段回落28|MDT ConfidentialUC201204429EETIMI 3 级血流级血流 无微血管灌注无微血管灌注Henriques JPS et al.EHJ 2002;23:1112-7Gibson CM et al.Circulation.2001;103:2550-2554Grade 5 thrombusGrade 4 thrombus1,1,1Dissection-Type DDissection flap po
7、st POBA in a heavily calcified lesion-Type CPerforationPerforationPrePostLADRCAIVUS interrogation has identified IH as the main cause of ISREur Heart J(2003)24(2):138-150.(2003)24(2):138-150.IVUS provides an attractive technique to characterise fully the pattern of stent thrombosis,to identify readi
8、ly the underlying mechanical predisposing factors,and to guide repeated coronary interventionsHeart.2004 December;90(12):14551459AEDCBFCase example of a 59 year old woman who presented with CS in the setting of STEMI(late presentation with ongoing symptoms).Initial angio showed thrombus LMS,CX(Panel
9、 A-arrow).Export aspiration cleared the thrombus(Panel B)with evidence of haziness in the ostial LMS(Panel C)confirmed on IVUS as a plaque in ostial LMS(Panel D)which was treated successfully with LMS stenting(Panel E),with widely patent stent at 3-month follow-up angio(Panel F).Cardiogenic shock in women.Kunadian et al.ICCL 2012Ruptured plaque visible on angio
