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1、分叉病变介入技巧ClassificationofbifurcationlesionsaccordingtoplaqueburdenA:DukeB:SanbornC:SafianD:LefevreMedinaA.etal.RevEspCardiol.2006;59:183-4ANewClassificationofCoronaryBifurcationLesions-MedinaClassification1,1,11,1,01,0,10,1,11,0,00,1,00,0,1MBDistalMBProximalSB一个
2、好还是两个好？如果选２个，应该采取何种策略?策略选择的根据简单化vs复杂化循证结果vs个人选择并发症率(especiallyMI/thrombosis)分叉病变介入治疗-关注热点Stentingforbifurcationlesionsin2007主支放支架，分支临时决定StentingthemainvesselwithprovisionalstentingofthesidebranchProvisionalStentingStrategyIf2ndstentisneededforsidebranchfollowin
3、gmainvesselstentingModifiedT-stentingReversecrushingCulottestenting分支血管的保护与放置支架并非所有分支血管同等重要!根据以下情况实施分支血管保护和支架植入分支血管大小与分布区域分支血管开口病变与病变程度分支与主支成角程度SidebranchclosureafterPCISide-branchmaybecompromisedfollowingmainvesselstentingPre-treatmentAfterstentingPlaqueshifti
4、ng(“Snow-plow”)OstialspasmorSide-branchcompromisebystentmaterialDissectionofplaqueatoriginofside-branchDissectionflapatmainarteryobstructingoriginofside-branchAttimes,thesidebranchcouldbecompromisedbythrombustooDifferenttechniquesoftwostentsbyintentiontotreatbi
5、furcationlesionsTheVstentingtechniqueThesimultaneouskissingstentstechniqueTheTstentingandmodifiedTstentingtechniqueThecrushtechnique(Thereversecrushtechnique/Thestepcrushtechnique/Theinvertedcrushtechnique)TheculottesstentingtechniqueTheYstentingtechniqueTheski
6、rttechniqueTheVstentingtechniqueThesimultaneouskissingstentstechniqueTheVstentingandthesimultaneouskissingstentingtechnique适合于分叉病变位于接近开口的血管近端，例如位于左主干的分叉病变，并且左主干短或无病变。理想夹角<90°。V支架也适合于其他部位的分叉病变，近段无病变或无须支架。TheVstentingandthesimultaneouskissingstentingtechnique优点:保
7、证不会丢失分支。对吻技术时无须re-crossanystent.TheVstentingandthesimultaneouskissingstentingtechnique缺点:双支架近端定位较困难；不可避免造成其中一个支架偏心，往往引起agap。TheTstentingtechniqueThemodifiedTstentingtechniqueTheTandmodifiedTstentingtechnique优点:较crush技术容易完成。缺点:大多数情况下，分支开口不能完全覆盖。ColomboetalCircul
8、ation2004;109:1244-1249*Highcross-overratefromStent+BalloontoStent+Stentgroup(22/43,51%)CypherBifurcationStenting(T-stenting)EffectsoftheTstentingtechniqueRESEARCHbifurcatio
