支架内再狭窄IVUS

会计学1支架内再狭窄支架内再狭窄IVUSHistory Summary67 year old malePresented with developed recurrent chest pain at restIn 2009,RCA stents for old inferior myocardial infarction(7 months ago)and unstable anginaIn 2010,repeat PCI for RCA and LAD because of unstable anginaHistory of Dislipidemia and hypothyroidism,smokerDiagnosis:unstable anginaAngiography of Oct 29,20092.015mm sprinter 10atmRCA Predilatation1.515mm sprinter 8atm3.030mm Endeavor 14atmRCA Stenting3.030mm Endeavor 12atmFinal AngiographyAngiography of Mar 15,2010RCA and LAD Stenting3.013mm Firebird 12atm3.018mm Firebird 12atmFinal AngiographyAngiography of Feb 11,2015RCA IVUSMLA=2.51mmMLA=2.51mm2 2RCA IVUSProximalProximalUnderexpansion?Underexpansion?DistalDistalDistal reference Distal reference Distal stentDistal stentMid stentMid stentProximal stentProximal stentProximalProximal referencereferenceRCA Intervention2.515mm Maverick 10atm 2.7517mm SeQuent Please DCB 14atm 40sFinal AngiographyRCA Final IVUSMLA=4.09mmMLA=4.09mm2 2DefinitionUse of IVUS in ISREvaluation for the patterns and mechanismEvaluation for the patterns and mechanismGuide the treatment selectionsGuide the treatment selectionsImportance of IVUS for ISRAngiographic ISR Classification confirmed by IVUSconfirmed by IVUSMehran,et al.Circulation.1999;100:1872-1878(10 mm)Mechanisms of DES RestenosisVasim Farooq,et al.The PCR-EAPCI Textbook Percutaneous Interventional Cardiovascular MedicineIn-stent Restenosis.Findings of IVUS for ISRStent Underexpansion:Final Stent Area：MSA5mm2,Stent lengthStent Edge RestenosisStent FractureDES Gap or Geographic Miss(Incomplete stent coverage)Non-Uniform Stent Expansion:Non-uniform Strut Distribution，DES Damage Intimal HyperplasiaBalloon PTCA(also Cutting Balloon)Drug-Coating BalloonsDrug-Eluting Stents(DES):Same or Different?Bioresorbable ScaffordBare Metal Stent(BMS)Brachytherapy(VBT)Rotablation(RA)/LaserMedical ManagementCABGTreatment Options of DES ISRStrategies for ISR TreatmentDCB or DESSummaryCurrent restenosis rates are lower than ever but can still present a challengeWe will treat restenosis differently based upon the mechanismThe current main cause of ISR is stent underexpansion in difficult lesions such as calcified,long,small vesselsFor complex lesions,IVUS guided tailor-made PCI strategy is importantTHANK YOU。