1、1929年,德國醫生Wenner Forssmann在本人身上進展了人類首例心導管檢查術. 他將導管經左肘前靜脈,鎖骨下靜脈,上腔靜脈送入右心房,并拍了醫學史上第一張右心導管胸片,從此揭開了介入心臟病學的序幕.1959年Mason Sones 利用特制的尖端呈弧形的造影導管,經肱動脈送入自動脈根部進展自動脈造影,無意中將造影劑直接注入右冠狀動脈內使其明晰顯影,這一偶爾事件開創了冠脈介入診斷技術的新紀元1950s1960s1970sRyan Circulation 2002, 106:752-7561980s1990sRyan Circulation 2002, 106:752-7562021股

2、神經股總動脈股靜脈穿刺位置股骨頭腹股溝韌帶尺動脈橈動脈肱動脈橈動脈橈動脈掌淺弓掌淺弓尺動脈尺動脈Barbeau. G et al; Am Heart J 2004;147:489932 minBarbeau. G et al; Am Heart J 2004;147:48993NOJudkinsAmplatzTiger 導管導管JR4 導管導管左主干左主干(LM) 左前降支左前降支(LAD) 對角支對角支(D1, D2) 間隔支間隔支(septal) LADD1SeptalD2LMSRCAPLVINFPDAAM Radiographics 2007;27:1569-1582Radiograph

3、ics 2007;27:1569-1582Marginal branchConus branchMarginal branch盤旋支盤旋支 (Cx) 鈍緣支鈍緣支 (OM1, OM2)OM1CXOM2LAD Radiographics 2007;27:1569-1582OMOMLMSCXCXOMRadiographics 2007;27:1569-1582IMCXLMS后側支(PL)后降支(PD)左主干來源于右冠竇radiologyassistant.nl/en/48275120e2ed5Myocardial bridge in LADradiologyassistant.nl/en/4827

4、5120e2ed5A 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 TFC (cTFC) for normal coronary ar

5、teries 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 coronary artery by the acquisition rat

6、e (12.5, 25, 30 f/s) and dividing by the TFC. Gibson et al. Circulation 2000; 101:125-13027 | MDT ConfidentialUC201204429EEBrener SJ et al. Circ CV Interv. 2021;5:563-9Farkouh ME et al. Circ CV Interv. 2021;6:216-23心肌灌注分級TIMI血流ST段回落28 | MDT ConfidentialUC201204429EETIMI 3 級血流級血流 無微血管灌注無微血管灌注Henrique

7、s 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 as the main cause of ISREur Hear

8、t J (2003) 24 (2): -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 December; 90(12): 14551459AEDCBFCase example of a 59 year

9、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), wi