冠狀動(dòng)脈造影abc課件

冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件11959年MasonSones

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(wú)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(kāi)創(chuàng)了冠脈介入診斷技術(shù)的新紀(jì)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(gè)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(shí)內(nèi)的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治療斑塊消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的發(fā)病機(jī)制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分級(jí))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(dòng)脈及橈動(dòng)脈路徑股神經(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)脈冠脈造影

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

導(dǎo)管JudkinsAmplatzTiger導(dǎo)管JR4導(dǎo)管冠脈造影導(dǎo)管JudkinsAmplatzTiger導(dǎo)管J11冠脈解剖學(xué)左主干(LM)左前降支(LAD)對(duì)角支(D1,D2)間隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脈解剖學(xué)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(dòng)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(shì):

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左優(yōu)勢(shì):

ThisoccurswhenallthreebranchesarisefromtheCX.冠脈優(yōu)勢(shì)型后側(cè)支(PL)后降支(PD)右優(yōu)勢(shì):冠脈優(yōu)勢(shì)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(dòng)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(yuǎn)端參考血管直徑:4.病變長(zhǎng)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(kāi)口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病變特征描述偏心:Theplaqueistwice23TIMI血流分級(jí)TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分級(jí)TIMIFlowgrade:TFG0T24TIMI計(jì)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(jì)幀TIMIFrameCount:Gibson25TIMI心肌灌注分級(jí)TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分級(jí)TIMIMyocardialPer26直接PCI后，雖然心外膜冠狀動(dòng)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(jí)TIMI血流ST段回落直接PCI后，雖然心外膜冠狀動(dòng)脈血流率高，但再灌注未成功Br鏡下遠(yuǎn)端栓子和無(wú)復(fù)流

TIMI3級(jí)血流

無(wú)微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7鏡下遠(yuǎn)端栓子和無(wú)復(fù)流

TIMI3級(jí)血流無(wú)微血管灌注He血栓分級(jí)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(jí)Grade0:Nocine-angiogra29動(dòng)脈瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

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

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.動(dòng)脈瘤Alocalizedarterialwideni30病變復(fù)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(fù)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(jí)

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(jí) 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(yuǎn)端栓塞:TheappearanceofanabruptcutoffinthedistalvesselfollowingPTCA.無(wú)復(fù)流:Markedlydelayedflowdownthearterywithminimalresidualstenosis.其他遠(yuǎn)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(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件冠狀動(dòng)脈造影abcppt課件411959年MasonSones

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(wú)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(kāi)創(chuàng)了冠脈介入診斷技術(shù)的新紀(jì)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(gè)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(shí)內(nèi)的血栓自溶)Plaqueregressionstudiesuncoveringtheclinicalbenefitsofstatintherapy(他汀治療斑塊消褪)DelineationofthepathogenesisofAMIfromstudiesoutliningangiographicprogressiontoMI(AMI的發(fā)病機(jī)制)EstimatesofcoronaryflowusingTFGandTFCComparisonsofPCIvsCABGforrevascularizationoutcomesStentseraMyocardialblush(心肌染色分級(jí))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(dòng)脈及橈動(dòng)脈路徑股神經(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)脈冠脈造影

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

導(dǎo)管JudkinsAmplatzTiger導(dǎo)管JR4導(dǎo)管冠脈造影導(dǎo)管JudkinsAmplatzTiger導(dǎo)管J51冠脈解剖學(xué)左主干(LM)左前降支(LAD)對(duì)角支(D1,D2)間隔支(septal)LADD1SeptalD2LMSRCAPLVINFPDAAM冠脈解剖學(xué)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(dòng)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(shì):

Thisoccurswhenthedescending,inferior,andposteriorbranchesallarisefromtheRCA.均衡型:

ThisoccurswhenonlythedescendingbrancharisesfromtheRCA,whiletheinferiorandposteriorbranchesarisefromtheCX.左優(yōu)勢(shì):

ThisoccurswhenallthreebranchesarisefromtheCX.冠脈優(yōu)勢(shì)型后側(cè)支(PL)后降支(PD)右優(yōu)勢(shì):冠脈優(yōu)勢(shì)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(dòng)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(yuǎn)端參考血管直徑:4.病變長(zhǎng)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(kāi)口:

Lesionbeginningwithin3-5mmoftheoriginofamajorepicardialartery.BifurcationOstial病變特征描述偏心:Theplaqueistwice63TIMI血流分級(jí)TIMIFlowgrade:ClassificationofTFGGrade0,noperfusionGrade1,penetrationwithoutperfusionGrade2,partialperfusionGrade3,completeperfusionTFG0TFG1TFG2TFG3TIMI血流分級(jí)TIMIFlowgrade:TFG0T64TIMI計(jì)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(jì)幀TIMIFrameCount:Gibson65TIMI心肌灌注分級(jí)TIMIMyocardialPerfusionGrade:TMPG0:Failureofdyetoenterthemicrovasculature.TMPG1:Dyeslowlyentersbutfailstoexitthemicrovasculature.TMPG2:Delayedentryandexitofdyefromthemicrovasculature.TMPG3:Normalentryandexitofdyefromthemicrovasculature.Gibsonetal.Circulation2000;101:125-130TIMI心肌灌注分級(jí)TIMIMyocardialPer66直接PCI后，雖然心外膜冠狀動(dòng)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(jí)TIMI血流ST段回落直接PCI后，雖然心外膜冠狀動(dòng)脈血流率高，但再灌注未成功Br鏡下遠(yuǎn)端栓子和無(wú)復(fù)流

TIMI3級(jí)血流

無(wú)微血管灌注HenriquesJPSetal.EHJ2002;23:1112-7鏡下遠(yuǎn)端栓子和無(wú)復(fù)流

TIMI3級(jí)血流無(wú)微血管灌注He血栓分級(jí)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(jí)Grade0:Nocine-angiogra69動(dòng)脈瘤Alocalizedarterialwidening(dilatation)thatusuallymanifestsitselfasabulge.Itspresencemayleadtoweakeningofthewallandeventualrupture.Grade0:

None–noectasiapresent.Grade1:

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

Aneurysm–visualassessmentofananeurysm>1.5timesthenormalarterydiameterlocatedanywhereintheculpritartery.動(dòng)脈瘤Alocalizedarterialwideni70病變復(fù)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(fù)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(jí)

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(jí) Anin