CTO病变治疗策略幻灯片

lti-vessel disease with CTOРCTO病变比率Р30%Р70%РPatients with TotalРOcclusionsРPatients withoutРTotal OcclusionsРSource: Cardiac Data Resources, The BLG GroupР30% of patients have one or more total occlusionsРCTO病变血管再通的理论价值Р延长生命?改善左室功能?增加心肌电活动稳定性,减少心律失常事件?增加以后可能出现的冠状动脉闭塞事件耐受性?减少CABG?提高生活质量Р开通CTO的理由- ?生存率结果Р2,007 Consecutive CTO patients ?June 1980 – December 1999 ?…distinct 10-year survival advantage for essful CTO pared to failed CTO treatment.(73.5% vs 65.1%, p=0.001) Suero et. al - August 2001РCTO病变介入治疗的难度Р非CTO病变的介入治疗成功率: >95%?CTO病变的介入治疗成功率: 大约 60%?The major determinant of ess is passage of the guide wire across the lesion!!!РJ-CTO评分?简单0分?复杂1分?困难2分?非常困难3分РCTO病变介入治疗的策略Р正向开通策略?逆向开通策略?Hybird综合策略Р正向开通策略的适应症Р近段纤维帽清晰并且闭塞段较短(<20 mm),可首选正向导丝升级技术? 如果闭塞段较长(>20 mm),远段纤维帽后相对病变较轻,且分支清晰,首选正向导丝再进入(ADR)策略