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慢性完全闭塞之个人观点.ppt

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PaulHsien-LiKao,MDAssistantProfessorNationalTaiwanUniversityMedicalSchool&lusionPersonalThoughtsLastfrontiersforPCIWiththeadvancementintechniquesandequipments,indicationsofpercutaneouscoronaryintervention(PCI)plexlesionsubsetsinallhighriskpatientspopulationsLeftmain(LM)lusion(CTO)remainthelastfrontiersforPCICTO:essrate50-70%essratedependsonthepatientselectioncriteria,equipmentavailability,aswellastheinterventionaltechniqueRestenosisrateafterCTOrecanalizationishigh50-70%afterballoononlySignificantre-stenosisandre-occlusionratesdespiteBMSWhyshouldweopenaCTO?ImprovesperfusiontoviabletissuewithischemiaImprovesperfusiontohibernationtissuewithdepressedcontractilefunctionProvideandincreasecollateralperfusiontootherviablemyocardialterritoryAvoidordeferCABG,makinglessinvasivehybridprocedurepossibleImprovesclinicalsymptomsandlong-termsurvivalTOAST-ess(N=286)Failure(N=83)P-valueAlldeath3(%)3(%)(%)3(%)-fatalQMI1(%--Non-fatalNQMI1(%)3(%)(%)6(%)(%)13(%)<(%)19()(%)21()-%essofCTOPCIOlivarietat.‘lusionInterruptionoflumenforacertaindistanceTIMI0orTIMI1(lusion)oACSwithin3months,ordocumented>3monthswithpriorangiogramCollaterals>Gr2shouldbepresentIndicationforPCIAnginaSilentorangina-equivalentsymptomswithischemiashowninnon-invasivestudiessuchasthallium201scanEssentialsforCTOPCIBi-planecinewithgoodqualityfluoroscopySelectionsofdevices6-8FGCofvariouscurveMicro-catheter(personalfavoriteisExcelsior)CTOGW(personalfavoriteisConquestfamily)-,rotablatorHydrophilicGWforretrogradeapproach(personalfavoriteisFielder)CardiacechoandpericardialtappingkitjustincasePersonalCTOexperienceRoutineattemptsforCTOstartedin1998,essrateuntil2002whendedicatedCTOdeviceswereavailableAnincreaseinCTOPCIcasevolumesince2004,withmoreinterestandthoughtsontheanatomyandtechniquesMDCTwasintroducedin2005Tornu

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