罗建方“拘禁”球囊分支保护技术.ppt

Side Branch Protection:Jailed Balloon Technique“拘禁拘禁”球囊分支保球囊分支保护技技术Luo Jianfang Luo Jianfang 罗罗建方建方建方建方Guangdong General HospitalGuangdong General HospitalDo not loss SB!?Your Strategy?Two-stent Two-stent T stent V stent Crush T stent V stent Crush cullote dedicated stent?cullote dedicated stent?Provisional stenting?Provisional stenting?Cross over and final Cross over and final kissing?kissing?Too small vessel!Provisional stentingStenting of the SB may be required in up to 51%.MB stenting can cause plaque shift,spasm,protrusion of the stent struts into the SBChanges in the bifurcation angleThe jailed balloon technique(JBT)is a novel modified provisional stenting technique that aims to maintain SB patency and improve SB access.Jailed Balloon Technique1.Both limbs of the bifurcation are accessed with 0.014“wire2.Predilatation of the MB with a standard semicompliant balloonStep 1Step 23.A monorail balloon that is sized to approximate the SB vessel diameter(generally 1.52.0 mm and of adequate length)The proximal marker of the SB balloon is positioned approximately(0-2 mm)proximal to the stentStep 3Jailed Balloon Technique4.The MB stent is deployed to nominal pressures,jailing the SB wire and balloonStep 4Jailed Balloon Technique5.If the SB has not been compromised(i.e.,TIMI 3 flow),then the trapped SB balloon is inflated to low pressure(6 ATMs)If there is less than TIMI 3 flow in the SB,routine balloon angioplasty is performed before the balloon and wire are removedJailed Balloon TechniqueStep 5Keep stent balloon initial position!6.The MB stent balloons position is maintained carefully during SB balloon removalJailed Balloon TechniqueStep 67.The stent balloon is then fully expanded to moderate or high pressure,optimization of MB stent apposition,and to correct any stent deformation as a result of the jailed-balloon inflationJailed Balloon TechniqueStep 78.Final angiography will then reveal whether or not recrossing through the stent struts into the SB is necessary for provisional angioplasty and/or stenting.Jailed Balloon TechniqueStep 8Long Term OutcomeSome FindingsThe SB jailed balloon was removed in all patients without damage or entrapment of the balloon.JBT did not lead to any MB stent strut fractures Only one patient had stent deformation(IVUS)Reexpansion of the MB stent balloon after removing the jailed-balloon did not cause significant plaque shift.Flow model findingJBTKBThe caseJBT 2.0*20 pre dalitation 2.0*20 stent 3.0*33 LCX-ResultJBT 2.0*20Stent 3.0*18LAD-ResultTake Home MessageJBT has high rate of procedural success and SB patency in dealing with bifurcation lesions It simplifies the procedure,save time and may improve the long-term outcomeJBT may be a optimal option for protecting the lower size SB especiallyThank you!Thank you!