BTK 血管病变腔内治疗进展

邹英华北京大学 第一医院

根据术前造影显示胫前动脉、胫腓干、腓动脉及胫后动脉均可见残端，均可以尝试开通。而下段经侧枝显影的为胫后动脉和腓动脉可能开通更为容易

Case 1

腓动脉导丝通过并扩张

胫后动脉导丝通过并扩张

PTA 后造影

BTK 病变，AT 、 PT均闭塞。

注意胫前动脉短小盲端

Case 2

导丝试探通过ATA 闭塞段成功

分别扩张胫前动脉及腓动脉

正位下足动脉弓呈 α形

BTK 病变腔内治疗现状

• 腔内开通闭塞血管病变器材发展迅猛– 专用导丝、球囊、专用支架

• 腔内治疗开通闭塞病变技术逐渐成熟• 近期疗效满意？！• 长期疗效？• 近期再闭塞？！

POBA 后再狭窄的主要原因

• 血管弹性回缩：支架• 血管负面重塑：支架• 内膜增生：药物球囊

支架在 BTK 闭塞病变的应用效果？

均为冠脉支架，非专用支架

结 果

普通冠状动脉支架没有优势专用支架的研究如何？

药物洗脱支架与 POBA

161 patients enrolled

79 BMS82 SES

12 died

3 patients were lost to fu

8 died

4 patients were lost to fu

67 patients at 6 months follow-up64 patients at 6 months follow-up

3 died2 died

1 patient telephone contact2 patients telephone contact

62 patients at 12 months follow-up 63 patients at 12 months follow-up

1 patient was lost to fu

Angiologie

Herz-Zentrum Bad Krozingen

DES-BTK Study

P=0.004 (primary patency)P=0.005 (secondary patency)

Angiologie

Herz-Zentrum Bad Krozingen

Summary

• SES achieve significantly higher primary and secondary patency rates at 1 year as compared with BMS in the treatment of infrapopliteal lesions.

• The improvement in Rutherford-Becker class at 1 year was significantly better in the SES group.

• In the long run, the superior patency of SES may also improve limb salvage rates in patients with CLI Rutherford class 5 & 6 and an appropriate life expectancy.

Angiologie

Herz-Zentrum Bad Krozingen

POBA 与 DCB

小 结

• BKT 病变，尤其长段病变 POBA 治疗后再狭窄临床的主要问题

• 专用支架、药物洗脱支架的应用可降低再狭窄率。但使用位置受限

• 药物球囊的初步临床研究，结果令人鼓舞