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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

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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




PTA

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




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?




普通冠状动脉支架没有优势专用支架的研究如何?



Angiologie

Herz-Zentrum Bad Krozingen

DES-BTK Study

161 patientsenrolled

82 SES

79 BMS

12 died

8 died

4 patientswere lost tofu

3 patientswere lost tofu

2 patientstelephonecontact

1 patienttelephonecontact

64 patientsat 6 monthsfollow-up

67 patientsat 6 monthsfollow-up

2 died

3 died

1 patient was lost tofu

62 patientsat 12 monthsfollow-up

63 patientsat 12 monthsfollow-up


Angiologie

Herz-Zentrum Bad Krozingen

P=0.004 (primary patency)

P=0.005 (secondary patency)


Summary
Summary

Angiologie

Herz-Zentrum Bad Krozingen

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.


Poba dcb

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