個iros congress這是由Incathlab進(jìn)行現(xiàn)場直播

113秒-120

IROS…livestreambroadcastbythe‘in這是由Incathlab公司進(jìn)行的現(xiàn)場121秒-127SowewillhavethissessionnowinEnglish.因此，我們現(xiàn)在將用英語進(jìn)行。128秒-145秒Imayremindyouthatafterthislivestream,this ‘incathlab’willcutandeditthesessionanditshouldbeavailableontheInternet.我在這里提醒大家：現(xiàn)場后，Incathlab公司將對進(jìn)行剪輯，大家可146秒-149Theytoldmefewhoursorfewminutes151秒-23Ithinkwewillgointothisinterestingprogramwhichhasthetitle“abovethekneesnewadvancesintechniquesthatimprovethe 24秒-210Thereareinterestingpresentationsandtwocaseswhichwillbe211秒-230Myco-moderatorisDr.FussfromGermany.AndIthinkwewillstarttogointothefirstpresentation.Andthisiswhatmattersforoptimized esinthischallenginganatomy.我的合作仲裁者是來自德國的Fuss博士。我認(rèn)為開始第一個展示，就是在這個富有的解剖區(qū)域，什么對于優(yōu)化結(jié)果重要呢？231秒-236AndDr.HoffmannfromSwitzerlandwillgivethepresentation,有請來自的Hoffmann博士給我們做匯報演示237秒-45ItgotmeprettyawkwardtospeakEnglish,toapurelyGermanyspokenaudience.Well,tryingtodothat.246秒-51Abovethekneechallenges:whatmattersfor esinthischallenging膝蓋之上的：在這個富有的解剖區(qū)域，什么對于優(yōu)化結(jié)果重要呢253秒-33Well,I’mprettygoodatthepessimisticside.SoI’mgonnabetakenthepositionofcurbingyour34秒-316That’saboutwhatwecanactuallyistoachievekindalikecautionyouwhatwedotoday,andwhereweactuallydothingsthatarenotcorrectiveandprobablydisadvantagesintermsofachievinggood 就是關(guān)于我們實際上能做的也就是做到我們現(xiàn)在正謹(jǐn)慎做的事情事實上我們在做著不317秒-327I’llleavetoZech,FunovicandKickuthtobemorethantheoptimisticsideandlyou‘hey,thisiswhatwedoandthisishowweactuallyoptimizetheir 328秒-345Let’sstartwiththeverybasicfactsthatSFAisunique,andherewhatweareaddressinghereisavesselrelevantaboutmuscle.Anditisaverychallengingterritory.這是一個非常具有性的領(lǐng)域。346秒-349It’sprobablymorechallengingthanthecoronarysystem.It’sprobablyevenmorechallengingthanthecarotidartery.它可能比冠狀動脈系統(tǒng)更加具有性。甚至可能比頸動脈更具有性350秒-43Andwehavetoaddressthatwiththeoptimaldeploymentstrategy,andwecertainlydohavetheoptimaltooloutofourtoolboxwhichishugebynow.44秒-410Andactuallyit’sprettyconfusingforthenoviceandtheinterventionisttoreallypicktheright411秒-416AndtheSFAischallenging,whyisitsochallenging,becauseitisrelevantaboutmuscleandthemuscleismovingat….SFA非常具有性，為什么這樣具有性呢？因為它與肌肉相關(guān)，肌肉…移動417秒-426Thereisnotonlyextension,contractioninthatvessel,butthereisalsoadistort,thereisflexion,thereiscompression.那根血管不僅可以伸展，收縮，而且也有一種的力量，哪里有彎曲，哪里就有壓縮427秒-435Andallofthisoccursduringourwalking,running,whatsoeversitting436秒-442Anditstandsthatwe’llsurviveinthatsituationwherewearereallyhavetogowithallthose443秒-459Intermsofourdailybusiness,shouldwebedtoreallydoaformativejacketreallycoverthewholelengthoftheSFAstent,eventhoughlatestcuttingedgearegonnafail?SFA支架的全長。500秒-520Andthisiswhatweactuallyexperiencehere.Manymanyofourpatientswhenweoverdothingsliketheystandtolong,wedoseefractures,wedoseedistortpartsofthestentgraft.Thisisreallynotwaytogo.521秒-523Theoptimaldevelopment524秒-541Well,ifyoulookatthepapersthatareoutthere.Thereisonefullmetaljacketpaperofthesuperficialfemoralartery,aretrospectivereviewmostlydonenotbyinterventionalradiologistsbutbyourfriendsfromvascularsurgery.如果我們看一下這些已經(jīng)的文獻(xiàn)，其中有一篇關(guān)于淺表股動脈的金屬外殼的文獻(xiàn)，一個542秒-549秒Andtheyputintheirmaterialandmethodsectionsomethinglikethestentswerethenironedtothevesselwallbypost-dilatation.550秒-614…Well,ifyoutreatyourstentlikea that’sprobablynottherightwaytodoit.AndI…kindoflikecautionyoutodoitthatwaybecausethisisproducinga6-monthpatencyrateofwhichwassoverydismalcomparedtoopensurgery,thatyoushouldn’treallygothat如果你像..對待你的支架，那可能不是正確的方式。提醒你謹(jǐn)慎處理它。因為它6個月55%，這與開放手術(shù)相比結(jié)果令人堪憂，你真的不應(yīng)該采取那種方式。615秒-634Anotherexperience,thattomeallyoccursmaybelikeeighttotenyearsago,wewerealwayspickingreallybigstents,wehadaunanimoussizeofsomethinglike7,8,9millimetersfortheSFAandwejustdeploythoseself-expansiblestents.8-10年前，我們總是想選擇更大的支架。我們7，8，9SFA的尺寸，我們剛剛放置了一個自我膨脹的支架。635秒-652秒Thosepatientsreturnedacoupleofmonthslater.Andacoupleofmonthslateritlookslikethis:wehadaverynarrowed,thinlumentheresurroundtheintimalhypersia.Supposedlyintimalhypersia,Idon’tknow.…653秒-73…Andthestentseemstobeactuallywonderingthroughthevesselwalllayerstotheevenbeyondthat.74秒-709

orThisissomethingthatyouseeifyouoversizedramatically.Westilldooversize這就是你看到的尺寸所產(chǎn)生的結(jié)果。我們?nèi)匀辉谧龀叽绲氖虑?10秒-718WhydoIbeabletostatethat?BecausethereissomeinventoriesdonebyAbbott719秒725Lookingatwhatisthereferencevesselsizeduringtheirstudies,prospective726秒-731AndthereferencevesselsizeoftheSFAisintheballparkoffivemillimetersusually.SFA5毫米范圍內(nèi)。732秒-744Ifreallymeasuredwithagoodcalibrationmethod，nowthestentfortheSFAbeingpickedoutoftheshelffromtheirstockismostlyundersize,sevenmillimeters.SFA支架來說尺寸不夠，7毫米。745秒-747Sothereisoversizingatleasttwo因此，至少有兩毫米的尺寸748秒-752Idon’tknowtwentythirtyfortypercentofoversizing.我不知道究竟是20%，30%還是40%的尺寸。753秒-754秒Thisissomethingthatweprobablyshouldnot755秒-800Ireallypicktheappropriatesizestentfortheappropriatesize801秒-805WedoseealotofpresentationsconcerninghowdoIdo我們確實看見很多關(guān)于這方面如何做的806秒-817AndoneofthesepresentationsbyAminoattheLINC2013forthedrugelutingballoontechnologystatedthathehasalwayspre-dilated,ngpre-dilatation.其中有一篇是Amino在LINC2013上做的有關(guān)藥物涂層球囊技術(shù)介紹總是在進(jìn)行預(yù)擴(kuò)張817秒-826Andheistryingtofindthepre-dilatationtothevesselsegmentthatwilllaterthenbeingcoveredbythedrug-coatedballoon.827秒-831Nevertheless,pre-dilatation,thisiswhathe mends832秒-837Thisiswhat mendedforallthesestentdeploymentstrategieswiththeSuperastentSuperaII838秒-854NowwhatwearewewantistoachieveifwestenttheSFA.Wewanttocoverthelesionwewanttocoveritwithastentthatpushesoutward.ThisiscausingsomechronicoutwardfortheSFA855秒-906Sothat’scenterlumennarrowingwereallywantIhavesomechronicoutwardpushingtowardstheque.907秒-926Butassoonaswereachthenominaldiameter,wedon’twantchronicoutwardanymore.Becausethischronicoutwardprobablyinducingintimalhypersiaresponsevesselwallandit’sprobablythecausingagentforthemostofournewintimalhypersiastenosis927秒-949IfwelookattheSuperastent,thereisverymeticulousdescription,thereisatableherethatlsyouhavetopre-dilateyourvesselsegmentwith6millimetersifyouwanttodeploya5millimetersstent,ifyouwanttodeploymenta6millimetersstentyoureallyhavetoover-dilatealmosttosevenmillimetersinordertobeabletodeploythatstent.Supera支架的話，它有明確的詳細(xì)描述。那里有一個表格告訴你如果你想7950秒-1001ThisprobablywhatexinswhytheSuperainitsoneyearpatencyratesisperformedbetterthantheotherstents,theself-expandablestents.Supera1002秒-1014Thereisanothercriticalissue.Aself-expandablestentliketheAbbottAbsoluteorlikethe…stentsdoeshaveachronicoutwardinordertostayince.1015秒-1027Ifwereallypickedtherightsizethenitwillstaythere,ifwepickonethatisnotcausingtoomuchchronicoutward,wearenotinducingtoomuchnewintimalhypersia.AndtheoutwardofSuperastentiszero.如果我們選擇一個不會引起太多外向推力的支架，不會誘導(dǎo)新生內(nèi)膜增厚。0。1028秒-1040Ifwewanttodeployit,hasreacheditsnominaldiameter,thereiszerooutward.Thatisprobablywhatisminimizingnewintimalhypersiaresponse.1041秒-1101Likewise,ifyouusedastentgraftyouprobablycanexcludenewintimalhypersiainthatlengthofthelumen,butyouinducenewintimalhypersiaattheedges,andthisiswhatcausesyouredgestenosisproblemandtheyfoundintheVAPERtrialifyouoversize,thereisalotVAPER實驗中發(fā)現(xiàn)，只要你尺寸選擇，就會有的狹窄。112秒-1118Theoptimaldeviceoutofthetoolbox.Well,whynotsurgery?Whynotbypassgrafting?It’sveryinterestingtoseecomparingthetrials,Ipickedonethatisreallygoesintothelongtermpatency現(xiàn)象，我選擇了一個研究長期支架暢通率的實驗?zāi)脕怼?119秒-1129AndthatshowsyouthatbothareperformingthesameareathisisastudydonebyvascularsurgerygroupinnewEngland,andtheyfoundcomparing140bypassgraftstoalmost200stentsintheSFA.140例搭橋和將近SFA1130秒-1157Theyfoundcomparableprimarypatencyratesandverycomparableassistedprimarypatencyatfouryears,sothestentisnotthatbadasitisprobablyconsiderbytheArmadaofdrug-coatedballoonusers.Armada1159秒-1211WorseresultsoccurinlongerlengthSFAlesions.Thisissomethingthatwehavetoconsiderassoonaswegoforlongerlengthlesions,theself-expandablestentisprobablynotthewaytogo.SFA1212秒-1221Let’strytosummarize.neoldballoonangiostyisprovidingis40-60%patencyrateat1year.Thisisnotadequate.…讓我們做下總結(jié)，POBA40-60%，這一結(jié)果并不足夠。1222秒-1231秒…Thisiscanbeusedifyouhaveawearetryingtoachieve.

results,butinthelongtermsshouldbeconsideredreally1231秒-1239Patencyratesofself-expandablestentsgointotheballparkofsixty-fivetoeighty-fivepercentoneyear,notthat1240秒-1249秒Andthiscanbehopefullyimprovedforalongerlengthlesionbecauserepeatedlydeclineforthoseifyouuse對于較長長度的病變這一情況有望改善，因為如果你使用…1250秒-1301Thedrugcoatedstentdoesprovidesomerestenosisprotectionfortheinitialtimeframeofoneyearprobablyoneandhalfayears.1301秒-1312Butnotbeyondofthat,andthepatencyrateofdrugcoatedballooniscertainlybetterthantheneoldballoonangiostyanditistrulybetterthanaself-expandablewedon’tknow.1313秒-1324Wearereallylookingforsomethingthatwillbethereonlytemporarytoscaffoldourdiseasevessel,andthatisinthemakingrightnow.1325秒-1332Deploymentatorclosetonominalstentdiameteriskeytosuccess.Donotoversize,preparethevesselwithPre-Dilatation.1333秒-1348Andcertainlythefullmetaljacketisnotreallydoableatthecurrentpointoftime.Itcanbeusedforatemporaryvesselopeningifyouhaveastage-fourdisease.1349秒-1402neoldballoonangiostywithspot-stentingisprobablythemostreasonablestrategyrightnow.Longlesionsareprobablybettercoveredstentortreatedbysuperastent.POBASupera支1402秒-1404AndtemporaryScaffoldingisreallyonourwishlist.Thank臨時支架已經(jīng)列入我們的期待中。謝1413秒-1437Thankyouverymuch.Ithinkwewilldiscussattheendofthesession.Therefore,wewill…ontothefirstcasepresentation. pre-dilatationisabsoluyessential.Absolutecase…theUniversitatssptalBasel.AnditwillbepresentedbyMr.Zech博士呈現(xiàn)。1439秒-1446FirstIwanttointroducemypartnerwhichisMartinTakes,whichwillassistme.Andinthecase,mynameisChristophZech.首先要介紹下我的搭檔，MartinTakes，接下來他將輔助我完成操作，在這個病例里，ChristophZech。1447秒-1456We’refacingapatientwitharightSFAocclusionfromultrasoundfindingweknowitisabout20centimeterslong.超聲結(jié)果顯示這是一個右側(cè)SFA阻塞的，我們了解到病變大概是20厘米長1457秒-1459Thepatientis64yearsoldmalepatient.是一名64歲的老年患者。1500秒-1508秒HeisclaudicationstageIIb(Fontaine)withwalkingdistance50meters.It’slifestylelimitingforIIb501509秒-1516Forcardiovascularriskfactors,heisasmoker.He’shypertensionundertreatmentdyslipidaemiaunder對于心血管來說，他吸煙，有高血壓和血脂異常，目前正在接受治療1517秒-1531Primarymedicalhistoryisvaricosis.Medicaldedicationisaspirin,valsartan,amlodipine,andatorvastatin.Sotreatmentofhypertensionanddyslipidaemia.1532秒-1537Sofromultrasoundweknowthatitisaveryproximal1538秒-1550Weexpectonly1or2centimetersleftoftheSFA.Stillourfirstapproachistodoantegradepuncture,althoughweknowthatmightbedifficult.我們預(yù)期是一個1cm或2cm的SFA。盡管知道這種操作可能很，我們首先選擇的仍然1551秒-1558Ifweencounterdifficultyanditreallyisthe如果我們遇到，真的行不通的話，1559秒-1627秒

there,wewouldthenmovetocrossover……Fromhisbody…,thisisalsomightbeexpectedtobealittlebithard.Nevertheless,thereforewefirstgoprocedurewitha35-inchtformfirst,andwewillneeda6FrenchsheathtodoballoonangiostylaterwithArmadaballoon.Wemostlikelywillneedastent.WewanttochooseAbsoluteProstent.從他的身體…35英寸的平臺進(jìn)行操作，需要一個6F的鞘管，然后用Armada球囊進(jìn)行球囊成形術(shù)，我們可能需AbsolutePro支架。1628秒-1636Accordingtotheultrasoundmeasurements,wemaybeneedtwostentsandwithexpectedsizeofsixorsevenmillimeters.6-7mm1637秒-1640TheclosurewillafterwardsbedonewithStarclose隨后用Starclose裝置進(jìn)行關(guān)閉操作1641秒-1642秒That’sit.Wegoforthecase.1647秒-1710秒Sointhiscasewestartedwithantegradeapproach,butitwasnotsuccessfulduetohisocclusionoftheSFAclosetothebifurcationandthereisalotoftissueonthewaytothevessel.Soweswitchtocrossoverprocedure.1711秒-1714Soweseeaquitehigh1728秒-1741Sincethelongsheathhasnotcompleyinside,heisaquitetallpatient.Wehavetoexchangeforalittlebitlonger,…,sowechoosea5Frenchnow.的，…5F鞘管。1743秒-1746Weforthefirsttimetakealookatthe1747秒-1757Ok,herewegotoseetherefilloftheSFAandsmallandslowfluidflowing,butpatentandotherwisefinepoplitealartery.1759秒-1810Ithinkfromthe wecanappreciatewhywehaddifficultyinenteringfromalthoughsometimesitis盡管有時是可能的，我們現(xiàn)在可以明白為什么順行進(jìn)入存在啦1811秒-1818Andifitispossible，thenthisofcourseisveryhelpfulforthe1819秒-1830Butactuallytheexpectedzoneofthreecentimetersangiographiclyisnotquitein1832秒-1836Canseenowtheslightoverlad,justhelpfultogetintotheright.現(xiàn)在我們可以看見有輕微的，可以幫助我們進(jìn)入右側(cè)。1837秒-1849秒YouseeactuallytheultrasoundisnotsowronginclaimingthreecentimetersofSFAleftwhichwedidnotseeduetoover-projectiononthepreviousimage.SFA1851秒-1900Nohighmagnificationtoreallyseehowthewiregoingon.Wedohavethebestimage1912秒-1922Soactuallyintheultrasoundreporttherewasabigcollalvesseldescribedwhichwenowseeveryclearly.因此超聲的有一個大的側(cè)枝循環(huán)血管，現(xiàn)在我們很清楚的看見1923秒-1931It’sthereasonwhythewirewasadvancinginthatway.Actuallyitseemsthatwearealittlebitfurtherdownbutit’salready.1936秒-1949Nowadvancetheguidecatheterjustalittle,probablywehavetoswitchtoballooncatheterafterwards.Ok,itlooksquitegood.1950秒-2003…Thewireisadvancingveryfast,thereisanannoyingintherightlumennow.Thatlooksgood.…

onthe

sowecan’tseewhetherit……2004秒-2014Andthesmallrealmofcalcificationthatlooksverypromising.Actuallythemostpromisingsignishowthewiremoves.……2019秒-2035……Ok

verygently.It’smaybeoneofthe

Thereisalreadysome好啦，輕輕地，可能是一個?！呀?jīng)有一些血流了2036秒-2043Asexpectednotsufficient.Weshouldreallykeepthatopen,butIthinkitlooksnot2053秒-2107FromtheultrasoundweknowthattheproximalSFAhad7-millimeterindiameter,andalmost6.6,so7-millimeterstentproximallywillbefine.SFA76.67毫米的支架將是可以選2111秒-2119Nowwehavetomeasurewhetherwehavelongenoughstentorwegowithtwostentsandthedistalonewithlessdiameter.現(xiàn)在須測量是否我們有足夠長的支架或我們可以選擇兩個支架遠(yuǎn)段放置較短直徑的2121秒-2129Sothedistanceistwenty-twocentimetersandwewillusetwoAbsolutePro距離是22cm，使用兩個AbsolutePro支架2131秒-2146Thisisourstent.AndasImentionedwehave releasesystemwhichgivesus,ascanseeherefromthatpoint,nomovementwhenreleaseitwhichisverynicefor2152秒-2158Crossthelesiononcetotallyandthenpullitlittle222秒-2208Seehowitopensexactlywherewewanttohaveit.Itdidn’t2218秒-2224Sotheproximalstentwechoosetheseven-millimeterdiameterand10-centimeterin7102226秒-2229Afterthiswe’llpost-dilatewithfive52241秒-2246Wecanseehownicelythesystem2249秒-2300SowenowtaketheArmada35balloontopost-dilatatewechoosealengthof20Armada35202303秒-2314Thedifficultareaisquitewell,wenowlookingatthe,rightnowalittlebit,OK,thatlooks2325秒-2329Ihaveatrynottogooutofthestented2335秒-2439Maybewecangothroughtheimagesagain.Wearequitehappywiththefoot…2340秒-2359…didn’thaveanylesions,soverylifestylelimitingclaudicationwasindicationweseebelow…kneevesselsquitewellasImentionedpreviouslyandthe ,wehavegood…2400秒-2407DuetothatsituationtheSFAispatentnow,theareawherewecedthestentlooksSFA249秒-2413I’mhappywiththis.Ittookalittlelongerthanweexpecteditto2415秒-2424Butthelesionwasreallyquitedifficulttopass,especiallyatthebeginning,becausetherewasthemutualcolla lwhichwaspassingtoright.2425秒-2429Sowewillalwaysenterthis lbutnow,theresultisvery2439秒-2454Lettingusdiscussitalsolateror.Iwouldliketodiscussthiscasejustnow.Ithinkitwasverywelldoneofcourseandyourecizedthisdifficultandchallenginglesion且富有性的病變再通2455秒-2510ButifyoufollowthepresentationofDr.Hoffmann,youshouldhavedonevesselpreparationintermsofpre-dilatationwiththeballoonwithsomekindofoversizing.Hoffmann醫(yī)生的講演內(nèi)容，你應(yīng)該通過球囊預(yù)擴(kuò)張來對血管進(jìn)行預(yù)處理，已達(dá)2410秒-2523Youhavedoneamoreorlessveryconventionaltechnique,ngsomesmallballoonpre-dilatation,thencedthestent,thendidballoondilatationwithinthestent.2423秒-2537SoafterhavingheardthepresentationofDr.Hoffmann,wouldyouchangeyourtechniqueinthefuture,woulddovesselpreparationintermsofalittledilatationbeforeyoucethestent.Hoffmann醫(yī)生的講演后，你會在將來改變你的技術(shù)嗎？會不會在放置支架前2538秒-2542Actually，Idon’tknowwhetheritisnecessarytogoforit2543秒-2555YouarerightthatifIcoulddoitrightnowagain,Iwould’verathertakeafiveorevensixmillimetersballoonforafterwardscing,thenthesixmillimetersstent.2556秒-2609Butifyoulookwhatisdoneoutinthefield,alotofpeople,Ithinkwhatisreallyimportantpointisthatyoucreateachannelandreallymakespaceforthestent.2610秒-2615It’smaybeoneortwomillimetersmore,it’sunderdiscussionhowmuchinfluenceithasonthe122616秒-2627Thereisalwaysabitofdiscussionthatwithregardtododistalembolizationtodotheprimarystentingwithoutanypreparation.Ithinkthatitisreallynotaverygoodidea.2628秒-2646Youshouldnotdothat.Ithinkthiskindofdilatationisquiteimportant,butinhowfar,howmuchpercentyouwillneedfortheactualstentintheend.Itisstillunclear.2647秒-2651Iwouldgoforalittlebitslighter,higherballoon2652秒-2656DrHoffmannoncegivesacommentandthenwemoveon.Hoffmann醫(yī)生一下看法，然后我們進(jìn)行下一個環(huán)節(jié)2657秒-2701秒Ifyoupre-dilatatedthatsegmentwhichisprettylong,Idon’tknowhowlongit2702秒-2710Youprobablyendedupinablockstentingofthatsub-intimalrecizationlengthandtherestwould’vebeenjustcoveredbytheballoon.2712秒-2724Althoughmaybeseveralexpertssawonlyonestepofdilatationhere,wedidthatfor2minutesanddidanotherfor2minuters,sowediditforalongertimeforsure.2725秒-2733ImeanIchangedmycurrentpracticetotallybyjustonlyngpre-dilatationforalltheseThey’reneverpost-2734秒-2738Putthestentinandthenpost-dilatateitisnolongerourcurrent2740秒-2754Ok,thankyouverymuch.Ithinkwemoveon.Ok,We’recomingtotheothertalk:Thetopic‘Absoluyright–trials es’PleaseProfessorFunovicfrom y正確——研究和結(jié)局，有請維也納的Funovic教授2756秒-2758秒Chairmenladiesandgentlemen好，們先生們2758秒-282You’venowYou’venowseenhowto ntthedevices283秒-2810NowletusseeinanoptimisticstandofpointasDr.HoffmannpointedouthowlongtheywillHoffmann2811秒-2820IfwetakealookatthelandmarksofstudiesconcerningtheSFAstenting,andplotthelesionlengthoverthetwelvemonthsofprimarypatency.SFA12個月的初始通暢率進(jìn)行2821秒-2827Wedoseeatransferdecreasepatencyinafteroneyearinthelonger2828秒-2836Andwithinthedifferentstudygroupsstillalargescatter.Andthere’sno 2837秒-2846Howpre-dilatationshouldbeperformed?Howstentselectionshouldbeperformedespeciallyinfractureresistantceandoversizing.2848秒-2858Sothetwodesign-inherentfactorsI’mgoingtofocusinthistalkisfracturecausingtheendothelialtraumaatthesiteofthefracturethatleadingtoearlyrestenosis.2859秒-299Andoversizingthatpotentiallyviaexcessiveradialtochronicirritationoftheintimalofthesmoothmusclelayer.Andagainitleadstoearlyrestenosis.2910秒-2928Itisnowwellestablishedthatthestentfracturesendadirectcontacttotheendothelialleadtorecruitmentofcellularmediatorsandmigratorymovedmusclecells,buildingupanewintimal,andleadingtothosewell-known eswithhighgradestenosisofthesiteofthe2929秒-2945Stentfractures,however,are inglessofaproblemwithmoremodernstentdesigns,withpolishsurfaces,withinactivatedsurfaces,andwiththebetterdesignsofbreachingstentsconnectingtheseparatestentrea.2946秒-2956Youseethatveryrecentstudiesshowstentfracturerateisabout2%comparedtoearlystentfracturerateoftwentytothirtypercent(20-30%)intheearlylandmarkstudies2958秒-3012秒Sowhatremainstobedesign-inherentandprobablyoperatordependentinthechoiceofthestentdesignandsize.It’sthefactofradialcausingpotentiallyearlyrestenosis.3013秒-3024Thisisatypicallyimageofstentthatisoversizedmigratesintothevesselwallovertimeanddoescausearestenosisoverthefulllengthofthestentsegment.這是一張尺寸過大的支架隨時間推移遷移入血管壁并引起支架全長再狹窄的典型3025秒-3032Butlookhowmuchbiggerthestentisinrespecttotheoriginalvessel3034秒-3042Weknowthereisaconnectionwithsevereoversizingindiverseanimalmodel3043秒-3100Inthisstudy,forexample,theyinsertedstentsiniliacarteriesofswinecouldshowhereistheblotofthestent-to-arterydiameterratiowithsevereoversizingwithstentsizesuptotwicethearterysize.3101秒-3111Thereisdefiniywellestablishedcorrelationatsixmonthsfollowupbetweenrestenosisandoversizing.Thesearethecorrespondinghistologicalimages.6個月時，再狹窄和尺寸過大有很明確的相關(guān)性，這是相關(guān)的組織學(xué)改變3113秒-3122Moderayorhardlyoversizedstentleadstoaverymoderatedepositionofnewintimainsidethestentstruts.3123秒-3133Anaveragelyoversizedstentleadstocorrespondinglyhigherbuildingupofnewintimalformationintheinternalelasticlamina.3133秒-3144What’sinsidetheinternalelasticlaminaisnewlybuiltupnewintima.What’soutsidetheelasticlaminamightbeactivestentmigrationintothevesselwallandthesurroundingtissue.3145秒-3154Andveryclearisthefactthatextremelyoversizing,howeverthisishardlyokinhumanstudywhenthestentistwicethesizeofthevessel.3155秒-3204Thereisanotherproblemandthismighthelpusalittlebitindeterminingwhetheroptimalvesselpreparationisnecessaryormandatory.3205秒-3218Wedohavedifferentchronicoutwardifthestentinsomeregionsofthelesionisnotallowedtoexpansetoitsfulldiameterwhichisoftenthecaseinseverestenosisorheavilycalcifiedlesions.3219秒-3236Here,apropervesselpreparationmighthelpinsmoothingoutthoseareasofveryhighchronicoutwardwheresignificantrestenosisispresent.There’sanotherthingthatchangesthe3236秒-3247ProfessorHoffmannhasnicelypointedout.Howmanyinfluencesfromtheoutsidetortureourstentandduringthemovementandthemuscleactivation,thestentcanbecompressedtoextremesizes.Hoffmann教授已經(jīng)為我們。在運動過程中以及肌肉激活過程中，外部支架會造3248秒-3303Theseare6-millimeterstentsinsertedin5-millimeterartery.Butlookhowhighthegradeofcompressionisatsomepointduringflexure,anditcaneasilygodownto50%ofthenominalstentdiameter.3305秒-3316Nowweknowthatthereisalsoamaterialcomesintoy.Itisnottheamountofoversizingalonethatdeterminesthechronicoutward.3317秒-3331Becauseifplotcompressionbelowthenominalsizeovertheactuallyexertedchronicoutwardinnewton,youseesomestentshaveaflatcurvebecausetheyarespringconstant.3332秒-3341Thesteepnessofthecompressioncurveislower.Andotherstentshaveaninitiallyhigh,thenaflatpartofthecurve.3341秒-3352Andtheniftheyarecompressedincaseof6-millimeterstentbelowtothirdoftheoriginaldiameter,theovercompressioncurve esverysteep.63352秒-3401Somistakesinsizingthatbringuswiththesestentfabricateintothesteepareaofthecurvecanleadtoextremelyhighchronicoutwardinsomeces.3402秒-3332…Anditmightbepreferring…,especiallywhenweenterthepoplitealartery …femoralartery,touseastentwithaflatexpansioncurvethatgivesusmoresafetytonotexertoverlyexcessivechronicoutwardinsituationswherecompressionisexertedbeyond5millimetersthatweoriginallywantthestenttobecompressed.5毫米時，產(chǎn)生過大的慢性外推力3434秒-3452WhatwehavelearnedfromtheVIPERstudyisthatattimeswherefivemillimetersstentswerenotavailableandsix-millimeterstentgraftsinthisstudyhavebeenimntedeveninfemoralarteriesoffourorfivemillimetersin63453秒-3506Thatitwasthosearteriesthatledtoanexcessivenewintimalformationattherespectiveinflowandoutflowedgesofthestentgraft.Logically,theycannotgetrestenosisoverthefulllength.3507秒-3516ButifwedividetheVIPERpatientsintothosethathavebeenoversizedbutlessthan20percent,weseeamuchbetterpatency.3517秒-3528Heretheblackcurveatoneyear,ninety-onepercentprimarypatency.Asopposetothosethathavebeenoversizedbymorethan20percentwhereasthepatencyatoneyearisonlyseventy70%3530秒-3554SoanotherstudythathasbeenpresentedbyDr.SchroefromBelgian,CIRSE2011,observedabout100patientswithameanstenosislengthofaboutsixcentimeters,andabout20%occlusionand80%stenosisintheSFA.Andthisstudyhasaverylongfollow-up.20%80%的狹窄。且隨訪時間很長。3556秒-3512SoDr.SchroereportedthatheonlyuseAbsolutestentwithaveryflatexpansioncurve.Veryencouragingprimarypatencyresultsare87%atoneyearand71%primarypatencyatfiveyears.87%，571%。3613秒-22Andifwelook,takeanotherlookatthecurve,allthatIpresentedatthebeginningofthestudy,thisputshiminthetopfield..3622秒-33And,onereasonmightalsobethatthereisaconnectionbetweentheflatexpansioncurveandtheavoidanceofexcessivechronicoutwardinobtaininggoodresults.3633秒-46SoweinViennadidaretrospectivestudytodetermineifthereisreallyanactualbetweenoversizingand3647秒-51Thiswasaretrospectivedatamining3651秒-3710Andwetookpatientsoutofstudieswheretheone-yearfollow-uphasbeenscheduledandthepatientwassupposedtoshowupindependentofoccurrenceofanysymptomsforhisone-yearfollow-upeitherwithultrasound,CTAorMRA,orarepeatedangiography.3710秒-Weyzedthestentdiameterandotherco-variablesandputitintotheconnectionwiththenominalstentsizeintocorrelationwiththehealthyvesseldiametertodeterminetheamountof3726秒-36And,weonlyusedthoseveryreliablemeasurementcouldbemadewitharulerorsomeothercalibrationdeviceincetheangiographyimages.我們只采用尺或其校準(zhǔn)裝置等非?？煽康臏y量方式對血管造影的圖像進(jìn)3736秒-56Soifwetakealook,wehavealreadyincluded30patientspredominantlymale,andwehavet