冠狀動(dòng)脈造影ABC

1、冠心病介入診療-ABC1929年,德國(guó)醫(yī)生Wenner Forssmann在自己身上進(jìn)行了人類首例心導(dǎo)管檢查術(shù). 他將導(dǎo)管經(jīng)左肘前靜脈,鎖骨下靜脈,上腔靜脈送入右心房,并拍了醫(yī)學(xué)史上第一張右心導(dǎo)管胸片,從此揭開了介入心臟病學(xué)的序幕.1959年Mason Sones 利用特制的尖端呈弧形的造影導(dǎo)管,經(jīng)肱動(dòng)脈送入主動(dòng)脈根部進(jìn)行主動(dòng)脈造影,無意中將造影劑直接注入右冠狀動(dòng)脈內(nèi)使其清晰顯影,這一偶然事件開創(chuàng)了冠脈介入診斷技術(shù)的新紀(jì)元1950s1960s1970sRyan Circulation 2002, 106:752-7561980s1990sRyan Circulation 2002, 106:7

2、52-7562013股神經(jīng)股總動(dòng)脈股靜脈穿刺位置股骨頭腹股溝韌帶尺動(dòng)脈橈動(dòng)脈肱動(dòng)脈橈動(dòng)橈動(dòng)脈脈掌淺弓掌淺弓尺尺動(dòng)動(dòng)脈脈Barbeau. G et al; Am Heart J 2004;147:489932 minBarbeau. G et al; Am Heart J 2004;147:48993NOJudkinsAmplatzTiger 導(dǎo)管導(dǎo)管JR4 導(dǎo)管導(dǎo)管左主干左主干(LM) 左前降支左前降支(LAD) 對(duì)角支對(duì)角支(D1, D2) 間隔支間隔支(septal) LADD1SeptalD2LMSRCAPLVINFPDAAM Radiographics 2007;27:1569-158

3、2Radiographics 2007;27:1569-1582Marginal branchConus branchMarginal branch回旋支回旋支 (Cx) 鈍緣支鈍緣支 (OM1, OM2)OM1CXOM2LAD Radiographics 2007;27:1569-1582OMOMLMSCXCXOMRadiographics 2007;27:1569-1582IMCXLMS后側(cè)支(PL)后降支(PD)左主干起源于右冠竇http:/www.radiologyassistant.nl/en/48275120e2ed5Myocardial bridge in LADhttp:/ww

4、w.radiologyassistant.nl/en/48275120e2ed5A myocardial bridge occurs when one of the coronary arteries tunnels through the myocardium rather than resting on top of the myocardium鈣化1234BifurcationOstialTFG0TFG1TFG2TFG3Gibson C M et al. Circulation 1999;99:1945-1950Gibson et al found a mean corrected TF

5、C (cTFC) for normal coronary arteries of 21 3.1 frames, yielding a 95% confidence interval for normal flow of (15, 27) frames.The Frame Count Reserve (FCR) can be calculated by dividing basal by hyperaemic TFC. The Frame Count Velocity (FCV) can be calculated by multiplying the length of the coronar

6、y artery by the acquisition rate (12.5, 25, 30 f/s) and dividing by the TFC. Gibson et al. Circulation 2000; 101:125-13028 | MDT ConfidentialUC201204429EEBrener SJ et al. Circ CV Interv. 2012;5:563-9Farkouh ME et al. Circ CV Interv. 2013;6:216-23心肌灌注分級(jí)TIMI血流ST段回落29 | MDT ConfidentialUC201204429EETIM

7、I 3 級(jí)血流級(jí)血流 無微血管灌注無微血管灌注Henriques JPS et al. EHJ 2002;23:1112-7Gibson CM et al. Circulation. 2001;103:2550-2554Grade 5 thrombusGrade 4 thrombus1,1,1Dissection-Type DDissection flap post POBA in a heavily calcified lesion- Type CPerforationPerforationPrePostLADRCAIVUS interrogation has identified IH a

8、s the main cause of ISREur Heart J (2003) 24 (2): 138-150. (2003) 24 (2): 138-150. IVUS provides an attractive technique to characterise fully the pattern of stent thrombosis, to identify readily the underlying mechanical predisposing factors, and to guide repeated coronary interventionsHeart. 2004

9、December; 90(12): 14551459AEDCBFCase example of a 59 year old woman who presented with CS in the setting of STEMI (late presentation with ongoing symptoms). Initial angio showed thrombus LMS, CX (Panel A- arrow). Export aspiration cleared the thrombus (Panel B) with evidence of haziness in the ostial LMS (Panel C) confirmed on IVUS as a plaque in ostial LMS (Panel D) which was treated successfully with LMS stenting (Panel E),