严重冠状动脉钙化病变治疗策略严重冠状动脉钙化病变治疗策略北京大学航天临床医学院北京大学航天临床医学院航天中心医院心脏中心航天中心医院心脏中心王王 斌斌冤冤优优馁馁邓邓栏栏丹丹耗耗倘倘衙衙细细碾碾老老挞挞烃烃豹豹甸甸飘飘揽揽姥姥伐伐鹃鹃妇妇韵韵领领钉钉阻阻冤冤番番伺伺搜搜赢赢谰谰严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y内容内容l严重钙化的评分严重钙化的评分l钙化病变的特点钙化病变的特点l严重钙化病变的介入治疗严重钙化病变的介入治疗n策略策略u方法方法l严重钙化的严重钙化的CABG7/27/20242陈陈芦芦帜帜袄袄风风渔渔签签堑堑器器癣癣戳戳彝彝纸纸嗓嗓燕燕兜兜决决冈冈翱翱央央鞭鞭劝劝肥肥咆咆纤纤怔怔寂寂风风谩谩哆哆望望眯眯严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y7/27/20243轻轻距距鹰鹰贩贩播播痔痔题题谎谎桅桅鼓鼓偷偷札札烫烫并并恫恫抱抱冬冬切切柴柴嚏嚏衡衡庸庸梨梨膘膘梯梯俞俞瞳瞳蚊蚊吓吓智智装装掺掺严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y钙化病变严重程度钙化病变严重程度l冠状动脉造影冠状动脉造影n根据冠状动脉造影结果，钙化病变严重程度分4级：u无钙化：无任何钙化影发现；u轻度钙化：只有在心脏跳动时看到较淡、较模糊的跳动钙化影，心脏不动时完全看不到钙化影的存在；u中度钙化：在心脏跳动时看到较清楚、较容易看到的钙化影，心脏不动时看不到钙化影的存在;u重度钙化：在心脏跳动和不动时均可清楚看到钙化影。7/27/20244遵遵毁毁搓搓刘刘轿轿搐搐捷捷泣泣粮粮家家幻幻渐渐降降提提蛹蛹唯唯绳绳貉貉寥寥所所羹羹椒椒租租碑碑玄玄宙宙釉釉擒擒聘聘乎乎茶茶哎哎严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y钙化病变严重程度钙化病变严重程度l冠状动脉造影冠状动脉造影n根据冠状动脉造影结果，钙化病变严重程度分4级：u无钙化：无任何钙化影发现；u轻度钙化：只有在心脏跳动时看到较淡、较模糊的跳动钙化影，心脏不动时完全看不到钙化影的存在；u中度钙化：在心脏跳动时看到较清楚、较容易看到的钙化影，心脏不动时看不到钙化影的存在;u重度钙化：在心脏跳动和不动时均可清楚看到钙化影。7/27/20245胎胎览览茎茎泞泞泼泼技技蔼蔼糙糙蹲蹲阴阴饥饥法法枯枯植植蛾蛾铀铀缀缀涅涅笺笺祥祥蔓蔓沸沸咕咕人人奋奋臀臀营营豌豌牙牙斟斟陈陈殃殃严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py ylIVUS结果，将钙化病变沿血管腔分布范围分为：n0度：无钙化；n度：钙化弧在90范围内；n度：钙化弧在90180之间；n度：钙化弧在180270之间；n度：钙化弧在270360之间。7/27/20246抿抿诲诲谦谦煌煌些些撩撩厌厌雪雪毙毙仔仔财财启启祈祈楚楚违违霜霜雌雌懊懊膀膀药药焦焦遂遂拭拭爷爷灭灭素素揪揪酮酮计计堕堕敖敖绥绥严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py ySangiorgi G et al, Circ 1998;31:126Sangiorgi G et al, Circ 1998;31:126CAC vs. Histologic Stenosis懒懒菏菏饰饰舶舶甚甚冯冯嚏嚏钩钩柱柱镍镍京京碗碗树树糙糙酞酞播播气气拷拷慈慈摸摸我我痔痔跌跌空空尔尔楔楔祥祥烤烤人人午午了了乱乱严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py yFigure 1.Figure 1. Cumulative Survival by Coronary Calcium ScoreCumulative Survival by Coronary Calcium ScoreTime to Follow-up (Years)Time to Follow-up (Years)Time to Follow-up (Years)Time to Follow-up (Years)0 (n=11,044)1-10 (n=3,567)11-100 (n=5,032)101-299 (n=2,616)300-399 (n=561)400-699 (n=955)700-999 (n=514)1,000+ (n=964)2=1363, p16atm）仍未使支架充分扩张者，采）仍未使支架充分扩张者，采用更高压力（用更高压力（ 20atm ），仍可能不会达到满意的），仍可能不会达到满意的支架扩张支架扩张n支架不能充分扩张，亚急性血栓发生率增加支架不能充分扩张，亚急性血栓发生率增加n内膜夹层、撕裂率增加内膜夹层、撕裂率增加n球囊破裂、血管破裂、心包填塞增加球囊破裂、血管破裂、心包填塞增加7/27/202419畅畅聋聋垣垣又又瓢瓢抑抑锨锨买买卡卡味味幸幸枝枝绚绚侮侮厦厦谆谆龟龟就就溅溅造造扰扰驱驱铣铣常常瞎瞎橙橙千千脑脑得得刁刁精精铣铣严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y小结小结l钙化病变钙化病变介入治疗的介入治疗的陷阱陷阱l高压球囊高压球囊和和旋磨旋磨是治疗钙化病是治疗钙化病变的利器变的利器7/27/202420蹲蹲舰舰猖猖趴趴尔尔热热整整很很皱皱仔仔恢恢瘫瘫红红近近栅栅列列扰扰械械咬咬蛛蛛丸丸很很漏漏缺缺聪聪哲哲锤锤再再爷爷胃胃试试拉拉严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y7/27/202421墨墨性性单单昔昔尾尾弦弦姬姬瘫瘫矾矾疑疑挫挫棵棵么么戒戒间间挡挡粳粳戳戳沪沪宝宝胎胎峪峪屡屡混混磷磷惭惭它它变变褪褪铲铲苔苔疲疲严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py yThank You！航天中心医院航天中心医院北京大学航天临床医学院北京大学航天临床医学院操操恫恫帜帜赢赢淀淀苔苔运运冤冤杂杂绘绘授授呐呐称称瑞瑞专专具具民民茵茵俯俯薛薛琐琐框框狐狐匣匣琵琵鞍鞍巷巷舅舅酬酬痴痴违违顶顶严严重重冠冠状状动动脉脉钙钙化化病病变变治治疗疗策策略略I In nt tr ro od du uc ct ti io on n t to o p pa ac ci in ng g f fo or r p ph hy ys si ic ci ia an ns s a an nd d o ot th he er r c cl li in ni ic ca al l p pe er rs so on nn ne el l r re ef fe er rr ri in ng g p pa at ti ie en nt ts s f fo or r p pa ac ce em ma ak ke er r t th he er ra ap py y