冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件11959年MasonSones

利用特制的尖端呈弧形的造影導管,經(jīng)肱動脈送入主動脈根部進行主動脈造影,無意中將造影劑直接注入右冠狀動脈內(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)的新紀元1959年MasonSones利用特制的尖端呈弧形的造影2冠脈造影50余年的歷程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脈造影)

Thefirsthumanstudies-severityandextentofCAD(首個人體研究)EarliestnaturalhistorystudiesofprovenCAD????DynamicvisualizationofLVperformance(左室造影)

DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronaryvasospasmandPrinzmetal’sangina(冠脈痙攣)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狹窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:752-756冠脈造影50余年的歷程!CAintroducedbyF3冠脈造影50余年的歷程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小時內(nèi)的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治療斑塊消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的發(fā)病機制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分級)Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脈造影50余年的歷程!Thrombolyticera,4冠脈造影

股動脈及橈動脈路徑股神經(jīng)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冠脈造影

股動脈及橈動脈路徑股神經(jīng)股總動脈股靜脈穿刺位置股骨5解剖學橈動脈掌淺弓尺動脈解剖學橈動脈掌淺弓尺動脈6Allen試驗Allen試驗7Allen試驗解讀Allen試驗解讀8AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minAssementofulnararchbyoxym9Barbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscoreBarbeau.Getal;AmHeartJ210冠脈造影

導管JudkinsAmplatzTiger導管JR4導管冠脈造影導管JudkinsAmplatzTiger導管J11冠脈解剖學左主干(LM)左前降支(LAD)對角支(D1,D2)間隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脈解剖學左主干(LM)LADD1SeptalD2LMSR12左前降支Radiographics2007;27:1569-1582左前降支Radiographics2007;27:15613Radiographics2007;27:1569-1582右冠狀動脈MarginalbranchConusbranchMarginalbranchRadiographics2007;27:1569-15814回旋支回旋支(Cx)鈍緣支(OM1,OM2)OM1CXOM2LAD回旋支OM1CXOM2LAD15Radiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics2007;27:1569-1516Radiographics2007;27:1569-1582中間支IMCXLMSRadiographics2007;27:1569-15817右優(yōu)勢:

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左優(yōu)勢:

ThisoccurswhenallthreebranchesarisefromtheCX.冠脈優(yōu)勢型后側(cè)支(PL)后降支(PD)右優(yōu)勢:冠脈優(yōu)勢型后側(cè)支(PL)后降支(PD)18冠脈起源異常左主干起源于右冠竇radiologyassistant.nl/en/48275120e2ed5冠脈起源異常左主干起源于右冠竇radiologyassist19心肌橋MyocardialbridgeinLADradiologyassistant.nl/en/48275120e2ed5Amyocardialbridgeoccurswhenoneofthecoronaryarteriestunnelsthroughthemyocardiumratherthanrestingontopofthemyocardium心肌橋MyocardialbridgeinLADrad20冠脈造影提供的信息定量冠脈造影分析冠脈血流心肌灌注其他特性:鈣化血栓潰瘍夾層動脈瘤鈣化冠脈造影提供的信息定量冠脈造影分析鈣化21定量冠脈造影分析(QCA)1近端參考血管直徑:2.最小直徑:3.遠端參考血管直徑:4.病變長度:直徑狹窄:1234定量冠脈造影分析(QCA)1近端參考血管直徑:123422病變特征描述偏心:Theplaqueistwiceaslargeononesideofthearterialbordercomparedwiththeother.鈣化:Readilyapparentdensitiesnotedwithintheapparentvascularwallatthesiteofthestenosis.彌漫:Lesionis≥20mminlength.分叉:Atheroscleroticplaqueinvolvestheoriginoftwoseparatearteries.開口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病變特征描述偏心:Theplaqueistwice23TIMI血流分級TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分級TIMIFlowgrade:TFG0T24TIMI計幀TIMIFrameCount:GibsonCMetal.Circulation1999;99:1945-1950GibsonetalfoundameancorrectedTFC(cTFC)fornormalcoronaryarteriesof213.1frames,yieldinga95%confidenceintervalfornormalflowof(15,27)frames.TheFrameCountReserve(FCR)canbecalculatedbydividingbasalbyhyperaemicTFC.TheFrameCountVelocity(FCV)canbecalculatedbymultiplyingthelengthofthecoronaryarterybytheacquisitionrate(12.5,25,30f/s)anddividingbytheTFC.TIMI計幀TIMIFrameCount:Gibson25TIMI心肌灌注分級TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分級TIMIMyocardialPer26直接PCI后，雖然心外膜冠狀動脈血流率高，但再灌注未成功BrenerSJetal.CircCVInterv.2012;5:563-9FarkouhMEetal.CircCVInterv.2013;6:216-23心肌灌注分級TIMI血流ST段回落直接PCI后，雖然心外膜冠狀動脈血流率高，但再灌注未成功Br鏡下遠端栓子和無復流

TIMI3級血流

無微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7鏡下遠端栓子和無復流

TIMI3級血流無微血管灌注He血栓分級Grade0:Nocine-angiographiccharacteristicsofthrombuspresent.Grade1:Hazy,possiblethrombuspresent.Angiographydemonstratescharacteristicssuchasreducedcontrastdensity,haziness,irregularlesioncontour,orasmoothconvex"meniscus"atthesiteoftotalocclusionsuggestivebutnotdiagnosticofthrombus.Grade2:

Thrombuspresent–smallsize:Definitethrombuswithgreatestdimensionslessthanorequalto1/2vesseldiameter.Grade3:

Thrombuspresent–moderatesize:Definitethrombusbutwithgreatestlineardimensiongreaterthan1/2butlessthan2vesseldiameters.Grade4:Thrombuspresent–largesize:AsinGrade3butwiththelargestdimensiongreaterthanorequalto2vesseldiameters.Grade5:Recenttotalocclusion,caninvolvesomecollateralizationbutusuallydoesnotinvolveextensivecollateralization,tendstohavea“beak”shapeandahazyedgeorappearanceofdistinctthrombus.Grade6:Chronictotalocclusion,usuallyinvolvingextensivecollateralization,tendstohavedistinct,bluntcutoff/edgeandwillgenerallyclotuptothenearestproximalsidebranch.GibsonCMetal.Circulation.2001;103:2550-2554Grade5thrombusGrade4thrombus血栓分級Grade0:Nocine-angiogra29動脈瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

Ectasia–visualassessmentofectasia>1&<1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.Grade2:

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.動脈瘤Alocalizedarterialwideni30病變復雜程度AHATaskForceDefinitionasmodifiedbyEllisetal:TypeA:<10mm,discrete,concentricreadilyaccessible,<45degreeanglesmoothcontour,littleornocalcification,lessthantotallyoccluded,notostial,nomajorsidebranchinvolvement,absenceofthrombus.TypeB1:Oneofthefollowingcharacteristics:TypeB2:Twoormoreofthefollowingcharacteristics:10-20mm,eccentric,moderatetortuosityofproximalsegment,irregularcontour,presenceofanythrombusgrade,moderateorheavycalcification,totalocclusion<3monthsold,ostiallesionorbifurcationlesion.TypeC:≥20mmdiffuse,excessivetortuosityofproximalsegment,totalocclusion>3monthsoldand/orbridgingcollaterals,

inabilitytoprotectmajorsidebranches,ordegeneratedveingraftwithfriablelesions. 病變復雜程度AHATaskForceDefinitio31分叉病變:Medina分型1,1,1分叉病變:Medina分型1,1,132夾層分級

Anintraluminalfillingdefectorflapassociatedwithahazy,ground-glassappearance.Thiscategoryissub-classifiedusingtheNHLBIsystemforgradingdissectiontypes:TypeA:Radiolucentareaswithinthecoronarylumenduringcontrastinjection,withminimalornopersistenceofcontrastafterdyehascleared.TypeB:Paralleltractsordoublelumenseparatedbyaradiolucentareaduringcontrastinjection,withminimalornopersistenceafterdyehascleared.TypeC:Contrastoutsidethecoronarylumen,withpersistenceofcontrastintheareaafterdyehascleared.TypeD:Spiralluminalfillingdefectsfrequentlywithextensivecontraststainingofthevessel.TypeE:Newpersistentfillingdefectsthatmaybecausedbythrombus.TypeF:ThesearenonA–Edissectiontypesthatleadtoimpairedflowortotalocclusionofthecoronaryartery.Dissection-TypeDDissectionflappostPOBAinaheavilycalcifiedlesion-TypeC夾層分級 Anintraluminalfillingd33其他穿孔:

Presenceofextra-luminalcontrastthatdevelops duringtheprocedure.分支丟失:

ThedevelopmentofTIMIgrade0or1flowinasidebranchthatwas>1.5mmindiameterpriortotheprocedureandwasinitiallypatentwithTIMIgrade2or3flow.手術(shù)成果:

Completesuccess:Ifthepost-procedurevisualresidualstenosisis<50%withnodecrementinflow.Partialsuccess:Ifthereiseithera>50%residualstenosisbyvisualassessmentorifTIMIGrade2Flowisattained(thisincludesTFG2.5).Failure:Ifthereisapersistenttotalocclusion,ifthelesioncannotbecrossed,orifthereispersistentabruptclosure.PerforationPerforationPrePost其他穿孔:PerforationPerforationPr34其他遠端栓塞:TheappearanceofanabruptcutoffinthedistalvesselfollowingPTCA.無復流:Markedlydelayedflowdownthearterywithminimalresidualstenosis.其他遠端栓塞:35側(cè)枝循環(huán)Partial:

Minimalcollateralspresent.Evidenceofminimaltopartialfillingoftherecipientbranchepicardialarteries/infarctregion.Complete:

Well-developedcollaterals.Evidenceofcollateralcirculationwithnearcompletetocompletefillingoftherecipientmajorepicardialartery/infarctregion.LADRCA側(cè)枝循環(huán)Partial:LADRCA36支架內(nèi)再狹窄IVUSinterrogationhasidentifiedIHasthemaincauseofISREurHeartJ(2003)24(2):138-150.支架內(nèi)再狹窄IVUSinterrogationhasi37支架內(nèi)血栓IVUSprovidesanattractivetechniquetocharacterisefullythepatternofstentthrombosis,toidentifyreadilytheunderlyingmechanicalpredisposingfactors,andtoguiderepeatedcoronaryinterventionsHeart.2004December;90(12):1455–1459支架內(nèi)血栓IVUSprovidesanattracti38AEDCBFCaseexampleofa59yearoldwomanwhopresentedwithCSinthesettingofSTEMI(latepresentationwithongoingsymptoms).InitialangioshowedthrombusLMS,CX(PanelA-arrow).Exportaspirationclearedthethrombus(PanelB)withevidenceofhazinessintheostialLMS(PanelC)confirmedonIVUSasaplaqueinostialLMS(PanelD)whichwastreatedsuccessfullywithLMSstenting(PanelE),withwidelypatentstentat3-monthfollow-upangio(PanelF).斑塊破裂,血栓形成/急性ST段抬高心梗Cardiogenicshockinwomen.Kunadianetal.ICCL2012RupturedplaquevisibleonangioAEDCBFCaseexampleofa59yea39謝謝！謝謝！40冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件冠狀動脈造影abcppt課件411959年MasonSones

利用特制的尖端呈弧形的造影導管,經(jīng)肱動脈送入主動脈根部進行主動脈造影,無意中將造影劑直接注入右冠狀動脈內(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)的新紀元1959年MasonSones利用特制的尖端呈弧形的造影42冠脈造影50余年的歷程!CAintroducedbyF.MasonSones,Jr,MD(首次冠脈造影)

Thefirsthumanstudies-severityandextentofCAD(首個人體研究)EarliestnaturalhistorystudiesofprovenCAD????DynamicvisualizationofLVperformance(左室造影)

DemonstrationofpromptandcompleterevascularizationbyCABGRefinementofnaturalhistorystudiesofunoperatedCADpatientsDiscoveryofthebenefitofCABGvs.MedRxinsubsetsofpatientsDelineationofcoronaryvasospasmandPrinzmetal’sangina(冠脈痙攣)Significanceofcoronarypathoanatomy(ulceration,thrombus,dissection,aneurysm,musclebridge,collateralvessels)IntroductionofPTCAanddelineationofrestenosis(PTCA及再狹窄)Firstangiographicevidenceofclotlysisinacoronaryvessel1950s1960s1970sRyanCirculation2002,106:752-756冠脈造影50余年的歷程!CAintroducedbyF43冠脈造影50余年的歷程!Thrombolyticera,withthedemonstrationofspontaneousfibrinolysisduring24hrsofacuteocclusions(心梗24小時內(nèi)的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治療斑塊消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的發(fā)病機制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分級)Brachytherapy,latestentthrombosis,andpharmocotherapyThecoronarycatheterandnewerimagingdevices(intravascularultrasound,MRI)1980s1990sRyanCirculation2002,106:752-7562013冠脈造影50余年的歷程!Thrombolyticera,44冠脈造影

股動脈及橈動脈路徑股神經(jīng)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冠脈造影

股動脈及橈動脈路徑股神經(jīng)股總動脈股靜脈穿刺位置股骨45解剖學橈動脈掌淺弓尺動脈解剖學橈動脈掌淺弓尺動脈46Allen試驗Allen試驗47Allen試驗解讀Allen試驗解讀48AssementofulnararchbyoxymetryAllen’stestissubjectiveanddifficulttointerpretBarbeauscoreBarbeau.Getal;AmHeartJ2004;147:489–932minAssementofulnararchbyoxym49Barbeau.Getal;AmHeartJ2004;147:489–93NOBarbeauscoreBarbeau.Getal;AmHeartJ250冠脈造影

導管JudkinsAmplatzTiger導管JR4導管冠脈造影導管JudkinsAmplatzTiger導管J51冠脈解剖學左主干(LM)左前降支(LAD)對角支(D1,D2)間隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脈解剖學左主干(LM)LADD1SeptalD2LMSR52左前降支Radiographics2007;27:1569-1582左前降支Radiographics2007;27:15653Radiographics2007;27:1569-1582右冠狀動脈MarginalbranchConusbranchMarginalbranchRadiographics2007;27:1569-15854回旋支回旋支(Cx)鈍緣支(OM1,OM2)OM1CXOM2LAD回旋支OM1CXOM2LAD55Radiographics2007;27:1569-1582回旋支OMOMLMSCXCXOMRadiographics2007;27:1569-1556Radiographics2007;27:1569-1582中間支IMCXLMSRadiographics2007;27:1569-15857右優(yōu)勢:

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左優(yōu)勢:

ThisoccurswhenallthreebranchesarisefromtheCX.冠脈優(yōu)勢型后側(cè)支(PL)后降支(PD)右優(yōu)勢:冠脈優(yōu)勢型后側(cè)支(PL)后降支(PD)58冠脈起源異常左主干起源于右冠竇radiologyassistant.nl/en/48275120e2ed5冠脈起源異常左主干起源于右冠竇radiologyassist59心肌橋MyocardialbridgeinLADradiologyassistant.nl/en/48275120e2ed5Amyocardialbridgeoccurswhenoneofthecoronaryarteriestunnelsthroughthemyocardiumratherthanrestingontopofthemyocardium心肌橋MyocardialbridgeinLADrad60冠脈造影提供的信息定量冠脈造影分析冠脈血流心肌灌注其他特性:鈣化血栓潰瘍夾層動脈瘤鈣化冠脈造影提供的信息定量冠脈造影分析鈣化61定量冠脈造影分析(QCA)1近端參考血管直徑:2.最小直徑:3.遠端參考血管直徑:4.病變長度:直徑狹窄:1234定量冠脈造影分析(QCA)1近端參考血管直徑:123462病變特征描述偏心:Theplaqueistwiceaslargeononesideofthearterialbordercomparedwiththeother.鈣化:Readilyapparentdensitiesnotedwithintheapparentvascularwallatthesiteofthestenosis.彌漫:Lesionis≥20mminlength.分叉:Atheroscleroticplaqueinvolvestheoriginoftwoseparatearteries.開口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病變特征描述偏心:Theplaqueistwice63TIMI血流分級TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分級TIMIFlowgrade:TFG0T64TIMI計幀TIMIFrameCount:GibsonCMetal.Circulation1999;99:1945-1950GibsonetalfoundameancorrectedTFC(cTFC)fornormalcoronaryarteriesof213.1frames,yieldinga95%confidenceintervalfornormalflowof(15,27)frames.TheFrameCountReserve(FCR)canbecalculatedbydividingbasalbyhyperaemicTFC.TheFrameCountVelocity(FCV)canbecalculatedbymultiplyingthelengthofthecoronaryarterybytheacquisitionrate(12.5,25,30f/s)anddividingbytheTFC.TIMI計幀TIMIFrameCount:Gibson65TIMI心肌灌注分級TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分級TIMIMyocardialPer66直接PCI后，雖然心外膜冠狀動脈血流率高，但再灌注未成功BrenerSJetal.CircCVInterv.2012;5:563-9FarkouhMEetal.CircCVInterv.2013;6:216-23心肌灌注分級TIMI血流ST段回落直接PCI后，雖然心外膜冠狀動脈血流率高，但再灌注未成功Br鏡下遠端栓子和無復流

TIMI3級血流

無微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7鏡下遠端栓子和無復流

TIMI3級血流無微血管灌注He血栓分級Grade0:Nocine-angiographiccharacteristicsofthrombuspresent.Grade1:Hazy,possiblethrombuspresent.Angiographydemonstratescharacteristicssuchasreducedcontrastdensity,haziness,irregularlesioncontour,orasmoothconvex"meniscus"atthesiteoftotalocclusionsuggestivebutnotdiagnosticofthrombus.Grade2:

Thrombuspresent–smallsize:Definitethrombuswithgreatestdimensionslessthanorequalto1/2vesseldiameter.Grade3:

Thrombuspresent–moderatesize:Definitethrombusbutwithgreatestlineardimensiongreaterthan1/2butlessthan2vesseldiameters.Grade4:Thrombuspresent–largesize:AsinGrade3butwiththelargestdimensiongreaterthanorequalto2vesseldiameters.Grade5:Recenttotalocclusion,caninvolvesomecollateralizationbutusuallydoesnotinvolveextensivecollateralization,tendstohavea“beak”shapeandahazyedgeorappearanceofdistinctthrombus.Grade6:Chronictotalocclusion,usuallyinvolvingextensivecollateralization,tendstohavedistinct,bluntcutoff/edgeandwillgenerallyclotuptothenearestproximalsidebranch.GibsonCMetal.Circulation.2001;103:2550-2554Grade5thrombusGrade4thrombus血栓分級Grade0:Nocine-angiogra69動脈瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

Ectasia–visualassessmentofectasia>1&<1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.Grade2:

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.動脈瘤Alocalizedarterialwideni70病變復雜程度AHATaskForceDefinitionasmodifiedbyEllisetal:TypeA:<10mm,discrete,concentricreadilyaccessible,<45degreeanglesmoothcontour,littleornocalcification,lessthantotallyoccluded,notostial,nomajorsidebranchinvolvement,absenceofthrombus.TypeB1:Oneofthefollowingcharacteristics:TypeB2:Twoormoreofthefollowingcharacteristics:10-20mm,eccentric,moderatetortuosityofproximalsegment,irregularcontour,presenceofanythrombusgrade,moderateorheavycalcification,totalocclusion<3monthsold,ostiallesionorbifurcationlesion.TypeC:≥20mmdiffuse,excessivetortuosityofproximalsegment,totalocclusion>3monthsoldand/orbridgingcollaterals,

inabilitytoprotectmajorsidebranches,ordegeneratedveingraftwithfriablelesions. 病變復雜程度AHATaskForceDefinitio71分叉病變:Medina分型1,1,1分叉病變:Medina分型1,1,172夾層分級

Anintraluminalfillingdefectorflapassociatedwithahazy,ground-glassappearance.Thiscategoryissub-classifiedusingtheNHLBIsystemforgradingdissectiontypes:TypeA:Radiolucentareaswithinthecoronarylumenduringcontrastinjection,withminimalornopersistenceofcontrastafterdyehascleared.TypeB:Paralleltractsordoublelumenseparatedbyaradiolucentareaduringcontrastinjection,withminimalornopersistenceafterdyehascleared.TypeC:Contrastoutsidethecoronarylumen,withpersistenceofcontrastintheareaafterdyehascleared.TypeD:Spiralluminalfillingdefectsfrequentlywithextensivecontraststainingofthevessel.TypeE:Newpersistentfillingdefectsthatmaybecausedbythrombus.TypeF:ThesearenonA–Edissectiontypesthatleadtoimpairedflowortotalocclusionofthecoronaryartery.Dissection-TypeDDissectionflappostPOBAinaheavilycalcifiedlesion-TypeC夾層分級 Anin