Transcript CTO的病理和组织学对手术策略的影响

广东省心血管病研究所
陈纪言
CTO病变的病理学和组织学对介入
手术的重要性
CTO-PCI受多种因素影响
术者技术和策略
-正向，逆向
-单导丝/平行导丝
-逆向导丝通过/对吻导丝/CART，反向CART
器械
-指引导管，微导管，导丝，球囊，支架
病变
- 没有完全一样的病变
-关键在于对病变的理解！！
Evolution of CTO:
extension and organization of the
thrombus
Evolution of CTO:
extension and organization
of the thrombus
病理学概念与介入策略
 Intimal plaque/subintimal space
内膜内斑块/内膜外腔
-内膜内导丝循径，内膜外导丝循径
-导丝成功通过的关键
 Micro-channel/loose tissue
微通道/疏松组织
-疏松组织循径
-导丝选择与操控
Intimal and Subintimal Space
due to Histopathologic
Examination
Subintimal Space is Expandable
(transverse & longitudinal)
Re-entry into the Distal Vessel
Lumen is Really Difficult
Stingray Coronary Re-Entry System
Stingray System (catheter and guidewire) is designed to accurately target and reenter the true lumen from a subintimal position in coronary arteries
Compatibility:
0.014”(.36mm)
and
0.018” (.46mm)
Wire
Unique selforienting
balloon has a
flat shape for
true lumen
targeting
Re-entry
probe at
Stingray
Guidewire tip
180° opposed and offset exit ports
for selective guidewire re-entry
IC-123702-AB Nov 2012
Procedural Details
CrossBoss® Catheter
1.
2.
3.
1
Stingray® Catheter
CrossBoss Catheter: is designed to quickly and safely deliver a guidewire via true lumen or
subintimal pathways
Stingray System (catheter and guidewire): is designed to accurately target and re-enter
the true lumen from a subintimal position
Stingray Guidewire: distal probe is designed for exit port selection and re-entry into the
vessel true lumen
2
3
IC-123702-AB Nov 2012
Tortuous & Calcified CTO
Lesion
导丝性能的改进是建立在对病变和血管
更深刻的理解上
 超控能力
 通过能力与通过效能
 Step up 与 step down
 导丝的顺应能力
IVUS Examination from the Subintimal Space
病理切片与IVUS的内膜外血肿比较
IVUS Guided Identification of
the Entry
Tortuous & Calcified CTO
Lesion
导丝性能的改进是建立在对病变和血管
更深刻的理解上
 超控能力
 通过能力与通过效能
 Step up 与 step down
 导丝的顺应能力
Key of Successful Antegrade
Wiring is “Intima Tracking”
IVUS Examination from the Subintimal Space
病理切片与IVUS的内膜外血肿比较
病理学概念与介入策略
 Intimal plaque/subintimal space
内膜内斑块/内膜外腔
-内膜内导丝循径，内膜外导丝循径
-导丝成功通过的关键
 Micro-channel/loose tissue
微通道/疏松组织
-疏松组织循径
-导丝选择与操控
VH Analysis of CTO
proximal
reference
distal
reference
Loose Tissue / Micro-channel
J Am Coll Cardiol Img 2010;3:797–805
疏松斑块寻径
疏松斑块寻径
How to Achieve “Intimal
Tracking”?
如何才能做到内膜内寻径？
Antegrade “Loose Tissue”
Tracking
Optimal Wire for Antegrade
Loose Tissue Tracking
 The wire can track loose tissue inside
CTO body within a few minutes.
 If there is no loose tissue at all, the
wire should not be advanced into the
sub-intimal space (or should not be
advanced behind the calcium in the
CTO body)
Antegrade Intentional Intimal
Tracking
CTO without Any Loose Tissue
Combination of Antegrade Loose
Tissue Tracking And Intentional
Intimal Tracking
小结
 介入医生对CTO病变的病理和组织学的理




解是CTO介入治疗的基础；
介入治疗前的阅片，必要时通过CT/IVUS检
查对病理学进一步理解；
介入治疗过程中导丝的信息反馈让我们加
深对病理形态的理解，
手术策略是在对CTO病理和组织学特征的
基础上所制定；
在深刻理解CTO病理的基础上，导丝选择
倾向使用软导丝，头端渐细及操控性能好
的导丝。
谢谢！