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BTK 血管病变腔内治疗进展. 邹英华 北京大学 第一医院. Case 1. 根据术前造影显示胫前动脉、胫腓干、腓动脉及胫后动脉均可见残端,均可以尝试开通。而下段经侧枝显影的为胫后动脉和腓动脉可能开通更为容易. 腓动脉导丝通过并扩张. 胫后动脉导丝通过并扩张. PTA 后 造影. Case 2. BTK 病变, AT 、 PT 均闭塞。 注意胫前动脉短小盲端. 导丝试探通过 ATA 闭塞段成功. 分别扩张胫前动脉及腓动脉. 正位下足动脉弓 呈 α 形. BTK 病变腔内治疗现状. 腔内开通闭塞血管病变器材发展迅猛 专用导丝、球囊、专用支架 - PowerPoint PPT Presentation
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BTK 血管病变腔内治疗进展
邹英华北京大学 第一医院
根据术前造影显示胫前动脉、胫腓干、腓动脉及胫后动脉均可见残端,均可以尝试开通。而下段经侧枝显影的为胫后动脉和腓动脉可能开通更为容易
Case 1
腓动脉导丝通过并扩张
胫后动脉导丝通过并扩张
PTA 后造影
BTK 病变,AT 、 PT均闭塞。
注意胫前动脉短小盲端
Case 2
导丝试探通过ATA 闭塞段成功
分别扩张胫前动脉及腓动脉
正位下足动脉弓呈 α形
BTK 病变腔内治疗现状
• 腔内开通闭塞血管病变器材发展迅猛– 专用导丝、球囊、专用支架
• 腔内治疗开通闭塞病变技术逐渐成熟• 近期疗效满意?!• 长期疗效?• 近期再闭塞?!
POBA 后再狭窄的主要原因
• 血管弹性回缩:支架• 血管负面重塑:支架• 内膜增生:药物球囊
支架在 BTK 闭塞病变的应用效果?
均为冠脉支架,非专用支架
结 果
普通冠状动脉支架没有优势专用支架的研究如何?
药物洗脱支架与 POBA
161 patients enrolled
79 BMS82 SES
12 died
3 patients were lost to fu
8 died
4 patients were lost to fu
67 patients at 6 months follow-up64 patients at 6 months follow-up
3 died2 died
1 patient telephone contact2 patients telephone contact
62 patients at 12 months follow-up 63 patients at 12 months follow-up
1 patient was lost to fu
Angiologie
Herz-Zentrum Bad Krozingen
DES-BTK Study
P=0.004 (primary patency)P=0.005 (secondary patency)
Angiologie
Herz-Zentrum Bad Krozingen
Summary
• SES achieve significantly higher primary and secondary patency rates at 1 year as compared with BMS in the treatment of infrapopliteal lesions.
• The improvement in Rutherford-Becker class at 1 year was significantly better in the SES group.
• In the long run, the superior patency of SES may also improve limb salvage rates in patients with CLI Rutherford class 5 & 6 and an appropriate life expectancy.
Angiologie
Herz-Zentrum Bad Krozingen
POBA 与 DCB
小 结
• BKT 病变,尤其长段病变 POBA 治疗后再狭窄临床的主要问题
• 专用支架、药物洗脱支架的应用可降低再狭窄率。但使用位置受限
• 药物球囊的初步临床研究,结果令人鼓舞