最新心脏介入治疗并发症PPT课件.ppt

心脏介入治疗并发症心脏介入治疗并发症Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention影响并发症发生的因素影响并发症发生的因素年龄年龄患者的健康状况患者的健康状况使用的设备和器材使用的设备和器材选择的手术方式选择的手术方式医生和其他人员的技术水平医生和其他人员的技术水平术后护理的质量术后护理的质量Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention术者的因素术者的因素决策与判断错误决策与判断错误器械选择不当器械选择不当操作粗暴操作粗暴Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionACC/AHA指南指南:心脏介入并发症分类心脏介入并发症分类死亡死亡死亡死亡 (0.5-1.4%)(0.5-1.4%)心肌梗死心肌梗死心肌梗死心肌梗死 (1-3%)(1-3%)CABG(CABG(包括择期包括择期包括择期包括择期/急诊急诊急诊急诊/紧急紧急紧急紧急)(0.2-3%)(0.2-3%)脑卒中脑卒中脑卒中脑卒中 (0.5%)(0.5%)血管穿刺部位并发症血管穿刺部位并发症血管穿刺部位并发症血管穿刺部位并发症 (1-3%)(1-3%)(出血、闭塞、夹层、假性动脉瘤、动静脉漏出血、闭塞、夹层、假性动脉瘤、动静脉漏出血、闭塞、夹层、假性动脉瘤、动静脉漏出血、闭塞、夹层、假性动脉瘤、动静脉漏)造影剂肾病造影剂肾病造影剂肾病造影剂肾病ACC/AHA PCIACC/AHA PCIACC/AHA PCI指南指南指南指南指南指南200120012001Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionPCI时增加死亡风险的因素时增加死亡风险的因素高龄高龄女性患者女性患者糖尿病糖尿病既往心肌梗死既往心肌梗死左心功能不全或肾功能不全左心功能不全或肾功能不全左主干病变左主干病变,或等同左主干病变或等同左主干病变多支血管病变多支血管病变ACC/AHA PCIACC/AHA PCIACC/AHA PCI指南指南指南指南指南指南200120012001Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention导致心肌梗死的原因导致心肌梗死的原因急性血管闭塞急性血管闭塞边支血管闭塞边支血管闭塞No-reflowNo-reflow或远端血管栓塞或远端血管栓塞亚急性支架血栓亚急性支架血栓 NSTEMINSTEMI发生率约发生率约发生率约发生率约5-10%STEMI5-10%STEMI发生率约发生率约发生率约发生率约1-3%1-3%Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention预防心肌梗死并发症预防心肌梗死并发症处理冠状动脉夹层处理冠状动脉夹层,防止急性闭塞防止急性闭塞保护边支血管保护边支血管,必要时置入支架必要时置入支架充分的抗血小板治疗充分的抗血小板治疗冠脉冠脉De novoDe novo病变病变,IIb/IIIaIIb/IIIa抑制剂治疗抑制剂治疗静脉桥血管病变静脉桥血管病变,远端保护装置远端保护装置Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention卒中并发症卒中并发症发生率发生率 0.38%19901999年间年间,9662例患者例患者,12407人次人次PCI,43例发生卒中例发生卒中高龄、左室射血分数低、糖尿病为卒中并发症高龄、左室射血分数低、糖尿病为卒中并发症 的独立预测因素的独立预测因素卒中患者预后差卒中患者预后差 院内死亡率为院内死亡率为37.2%,一年死亡率为一年死亡率为56.1%FuchsFuchs Shmuel et al.Circulation.2002;106:86-91.Shmuel et al.Circulation.2002;106:86-91.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention造影剂肾病的危险因素造影剂肾病的危险因素慢性肾功能不全慢性肾功能不全 糖尿病糖尿病高血压高血压充血性心力衰竭充血性心力衰竭高龄高龄低血容量低血容量PCIPCI相关的血流动力学不稳定相关的血流动力学不稳定大剂量的造影剂大剂量的造影剂药物的相互影响药物的相互影响(阿司匹林阿司匹林,ACEI,ACEI等等)造影剂肾病造影剂肾病造影剂肾病造影剂肾病造影剂肾病造影剂肾病:Cr:Cr:Cr水平较术前升高水平较术前升高水平较术前升高水平较术前升高水平较术前升高水平较术前升高25%25%25%或绝对值增加或绝对值增加或绝对值增加或绝对值增加或绝对值增加或绝对值增加0.5mg/dl0.5mg/dl0.5mg/dl90%90%的造影剂肾病出现的造影剂肾病出现的造影剂肾病出现的造影剂肾病出现于慢性肾功能不全患者于慢性肾功能不全患者于慢性肾功能不全患者于慢性肾功能不全患者Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention预防造影剂肾病的药物预防造影剂肾病的药物静脉注射含盐溶液静脉注射含盐溶液静脉注射含盐溶液静脉注射含盐溶液-水化治疗水化治疗水化治疗水化治疗 静脉注射优于口服静脉注射优于口服静脉注射优于口服静脉注射优于口服 等渗优于低渗等渗优于低渗等渗优于低渗等渗优于低渗 碳酸氢钠碳酸氢钠碳酸氢钠碳酸氢钠 术前术前术前术前6-126-12小时小时小时小时1ml/kg1ml/kg至术后至术后至术后至术后12-2412-24小时小时小时小时,根据心功能情况调整根据心功能情况调整根据心功能情况调整根据心功能情况调整,必要时利尿剂必要时利尿剂必要时利尿剂必要时利尿剂低渗或等渗造影剂低渗或等渗造影剂低渗或等渗造影剂低渗或等渗造影剂NN乙酰半胱氨酸乙酰半胱氨酸乙酰半胱氨酸乙酰半胱氨酸?呋塞米呋塞米呋塞米呋塞米,ANP,ANP,钙通道阻滞剂等钙通道阻滞剂等钙通道阻滞剂等钙通道阻滞剂等Am J Roentgenol Am J Roentgenol Am J Roentgenol 2004;2004;2004;183(6):1673-1689.183(6):1673-1689.183(6):1673-1689.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention 冠状动脉相关并发症冠状动脉相关并发症急性血管闭塞急性血管闭塞血管夹层血管夹层冠状动脉穿孔冠状动脉穿孔血管痉挛血管痉挛Slow-Flow与与No-Reflow气体栓塞气体栓塞Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性血管闭塞急性血管闭塞Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性血管闭塞急性血管闭塞:发生率发生率2%急性血管闭塞的临床因素急性血管闭塞的临床因素：心源性休克心源性休克 多支病变多支病变 高龄高龄 充血性心力衰竭充血性心力衰竭 肾功能不全肾功能不全 女性女性 糖尿病糖尿病 不稳定心绞痛不稳定心绞痛 急性心肌梗死急性心肌梗死Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性血管闭塞的病变因素急性血管闭塞的病变因素:含血栓病变含血栓病变 老化静脉桥老化静脉桥 分叉病变分叉病变 成角病变成角病变 病变远端迂曲病变远端迂曲 长病变长病变Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性血管闭塞常见原因急性血管闭塞常见原因血管夹层血管夹层 绝大多数为介入器械损伤所致绝大多数为介入器械损伤所致处理含血栓病变处理含血栓病变冠状动脉痉挛冠状动脉痉挛 但通常不是引起闭塞的直接原因但通常不是引起闭塞的直接原因Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性闭塞后患者死亡的决定因素急性闭塞后患者死亡的决定因素是否存在足够的侧支血管是否存在足够的侧支血管是否存在多支病变是否存在多支病变是否存在心功能低下是否存在心功能低下Jeopardy积分显示大片心肌处于危险之中积分显示大片心肌处于危险之中恢复冠脉前向血流所需的时间恢复冠脉前向血流所需的时间Catheter Cardiovasc Interv 2005Catheter Cardiovasc Interv 2005;64:395401.64:395401.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionJeopardy积分积分积分越高积分越高积分越高积分越高,血管闭塞后死亡风险越大血管闭塞后死亡风险越大血管闭塞后死亡风险越大血管闭塞后死亡风险越大!Ellis SG et al.Am J Cardiol 1991;68:1447-1451.Ellis SG et al.Am J Cardiol 1991;68:1447-1451.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性血管闭塞的临床症状急性血管闭塞的临床症状胸痛胸痛心电图变化心电图变化 ST段抬高或压低段抬高或压低低血压低血压心律失常心律失常 传导阻滞或室颤导致心性猝死传导阻滞或室颤导致心性猝死Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention急性闭塞急性闭塞冠脉内注射硝酸甘油冠脉内注射硝酸甘油冠脉内注射硝酸甘油冠脉内注射硝酸甘油100-200mcg100-200mcg100-200mcg100-200mcg重复重复重复重复PTCA(PTCA(球囊球囊球囊球囊/动脉动脉动脉动脉=1.0-1.1)=1.0-1.1)再次造影再次造影再次造影再次造影血管开通血管开通血管开通血管开通,观察观察观察观察10101010分钟分钟分钟分钟管腔直径稳定管腔直径稳定管腔直径稳定管腔直径稳定,残余狭残余狭残余狭残余狭窄窄窄窄30%30%30%30%支架支架支架支架,IIb/IIIa,IIb/IIIa,IIb/IIIa,IIb/IIIa抑制剂抑制剂抑制剂抑制剂应用肝素应用肝素应用肝素应用肝素12-24h,12-24h,12-24h,12-24h,监测监测监测监测ECGECGECGECG及心肌酶及心肌酶及心肌酶及心肌酶残余血栓残余血栓残余血栓残余血栓 造影剂染色造影剂染色造影剂染色造影剂染色 椭圆型充盈缺损椭圆型充盈缺损椭圆型充盈缺损椭圆型充盈缺损严重血管夹层严重血管夹层严重血管夹层严重血管夹层 前向血流受损前向血流受损前向血流受损前向血流受损 进展性缺血进展性缺血进展性缺血进展性缺血原因不明确原因不明确原因不明确原因不明确 多体位投照多体位投照多体位投照多体位投照 排除痉挛排除痉挛排除痉挛排除痉挛,左主左主左主左主 干夹层及气栓干夹层及气栓干夹层及气栓干夹层及气栓 IVUSIVUSIVUSIVUSIIb/IIIaIIb/IIIaIIb/IIIaIIb/IIIa抑制剂抑制剂抑制剂抑制剂支架支架支架支架?再次球囊扩张再次球囊扩张再次球囊扩张再次球囊扩张?溶栓溶栓溶栓溶栓AngiojetAngiojetAngiojetAngiojet及其它及其它及其它及其它 血栓抽吸装置血栓抽吸装置血栓抽吸装置血栓抽吸装置准备置入支架准备置入支架准备置入支架准备置入支架准备置入支架准备置入支架是是是是是是否否否否否否见后初始处理不理想流程见后初始处理不理想流程见后初始处理不理想流程见后初始处理不理想流程见后血管夹层处理流程见后血管夹层处理流程见后血管夹层处理流程见后血管夹层处理流程最具挑战性最具挑战性最具挑战性最具挑战性需谨慎处理需谨慎处理需谨慎处理需谨慎处理Catheter Cardiovasc Interv 2005Catheter Cardiovasc Interv 2005;64:395401.64:395401.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention血管直径血管直径血管直径血管直径2.5mm2.5mm2.5mm2.5mm2.5mm2.5mm2.5mmIIb/IIIaIIb/IIIaIIb/IIIaIIb/IIIa抑制剂抑制剂抑制剂抑制剂重复球囊扩张重复球囊扩张重复球囊扩张重复球囊扩张局限夹层局限夹层螺旋夹层螺旋夹层支架支架支架支架IIb/IIIaIIb/IIIaIIb/IIIaIIb/IIIa?DCA?DCA?DCA?DCA支架支架支架支架(多个或长支架多个或长支架多个或长支架多个或长支架)IIb/IIIaIIb/IIIaIIb/IIIaIIb/IIIa可接受的结果可接受的结果可接受的结果可接受的结果血管开通血管开通血管开通血管开通药物与药物与药物与药物与CABGCABGCABGCABG再扩张再扩张再扩张再扩张成功率成功率成功率成功率40-80%40-80%40-80%40-80%急诊搭桥急诊搭桥急诊搭桥急诊搭桥导丝或球囊不能通过病变导丝或球囊不能通过病变导丝或球囊不能通过病变导丝或球囊不能通过病变支架或球囊扩张后不理想支架或球囊扩张后不理想支架或球囊扩张后不理想支架或球囊扩张后不理想靶血管大靶血管大靶血管大靶血管大多支病变多支病变多支病变多支病变进展性缺血进展性缺血进展性缺血进展性缺血+血流动力学不稳定血流动力学不稳定血流动力学不稳定血流动力学不稳定药物治疗药物治疗药物治疗药物治疗小血管闭塞小血管闭塞小血管闭塞小血管闭塞小面积存活心肌小面积存活心肌小面积存活心肌小面积存活心肌侧支循环丰富侧支循环丰富侧支循环丰富侧支循环丰富血流动力学稳定血流动力学稳定血流动力学稳定血流动力学稳定外科手术适应证差外科手术适应证差外科手术适应证差外科手术适应证差是是是是是是否否否否否否血管夹层后急性闭塞血管夹层后急性闭塞血管夹层后急性闭塞血管夹层后急性闭塞Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠状动脉夹层冠状动脉夹层Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention发生夹层的常见因素发生夹层的常见因素病变因素病变因素 钙化钙化,偏心偏心,成角成角,长病变长病变,血管迂曲及血管迂曲及 复杂病变复杂病变(ACC/AHA病变病变B型或型或C型型)疾病因素疾病因素 急性心肌梗死或不稳定心绞痛急性心肌梗死或不稳定心绞痛器械因素器械因素 球囊或支架直径过大球囊或支架直径过大(球囊球囊/动脉直径动脉直径1.2)Amplazt导管导管,硬导丝等硬导丝等操作因素操作因素 深置指引导管深置指引导管(deep seating)等等Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠脉夹层冠脉夹层:NHLBI分型分型撕裂片位于血管内撕裂片位于血管内撕裂片位于血管内撕裂片位于血管内,很少或无造影剂滞留很少或无造影剂滞留很少或无造影剂滞留很少或无造影剂滞留可见真假腔可见真假腔可见真假腔可见真假腔少许或无造影剂滞留少许或无造影剂滞留少许或无造影剂滞留少许或无造影剂滞留造影剂渗至血管造影剂渗至血管造影剂渗至血管造影剂渗至血管外并有造影剂滞留外并有造影剂滞留外并有造影剂滞留外并有造影剂滞留螺旋型夹层螺旋型夹层螺旋型夹层螺旋型夹层新出现的持续新出现的持续新出现的持续新出现的持续存在的充盈缺损存在的充盈缺损存在的充盈缺损存在的充盈缺损远端血流缓慢远端血流缓慢远端血流缓慢远端血流缓慢血管接近闭塞血管接近闭塞血管接近闭塞血管接近闭塞Coronary Artery angiographic changes after PTCA:Coronary Artery angiographic changes after PTCA:Coronary Artery angiographic changes after PTCA:Manual of Operations NHBLI PTCA Registry 1985-6:9.Manual of Operations NHBLI PTCA Registry 1985-6:9.Manual of Operations NHBLI PTCA Registry 1985-6:9.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention置入支架后置入支架后,远端血管夹层远端血管夹层后果后果后果后果:形成支架血栓形成支架血栓形成支架血栓形成支架血栓处理处理处理处理:重叠置入支架重叠置入支架重叠置入支架重叠置入支架Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionJ Invasive Cardio 2003 15;2:89-92.J Invasive Cardio 2003 15;2:89-92.J Invasive Cardio 2003 15;2:89-92.右冠中段右冠中段右冠中段右冠中段右冠中段右冠中段2.52.52.5 20mm20mm20mm球囊扩球囊扩球囊扩球囊扩球囊扩球囊扩张后右冠及升主动脉发生夹层张后右冠及升主动脉发生夹层张后右冠及升主动脉发生夹层张后右冠及升主动脉发生夹层张后右冠及升主动脉发生夹层张后右冠及升主动脉发生夹层LAOLAOLAORAORAORAOComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠状动脉夹层可出现的临床表现冠状动脉夹层可出现的临床表现心绞痛心绞痛 ECG的的ST段可出现动态变化段可出现动态变化严重心律失常严重心律失常低血压低血压Cardiovascular CollapseComplications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention不同类型不同类型NHBLI夹层急性闭塞发生率夹层急性闭塞发生率NHBLI夹层类型夹层类型急性闭塞发生率急性闭塞发生率A02%B24%C10%D30%E9%F69%Catheter Cardiovasc Interv 2005Catheter Cardiovasc Interv 2005;64:395401.64:395401.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠脉夹层的后果及处理冠脉夹层的后果及处理A与与B型临床过程良好型临床过程良好,一般不会对手术一般不会对手术结果产生影响结果产生影响CF型夹层可增加患者死亡率型夹层可增加患者死亡率首选治疗首选治疗:确保导丝在血管真腔内确保导丝在血管真腔内,置入支架置入支架!Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠状动脉穿孔冠状动脉穿孔Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention冠状动脉穿孔危险因素冠状动脉穿孔危险因素临床因素临床因素临床因素临床因素 高龄高龄高龄高龄、女性患者女性患者女性患者女性患者病变因素：病变因素：病变因素：病变因素：钙化病变钙化病变钙化病变钙化病变,迂曲病变迂曲病变迂曲病变迂曲病变,成角及分叉病变成角及分叉病变成角及分叉病变成角及分叉病变,CTO,CTO器械与操作因素：器械与操作因素：器械与操作因素：器械与操作因素：硬的亲水导丝硬的亲水导丝硬的亲水导丝硬的亲水导丝,切割球囊切割球囊切割球囊切割球囊,直径过大的球囊直径过大的球囊直径过大的球囊直径过大的球囊,或或或或 球囊破裂球囊破裂球囊破裂球囊破裂(特别是针孔样破裂特别是针孔样破裂特别是针孔样破裂特别是针孔样破裂)应用旋磨应用旋磨应用旋磨应用旋磨,旋切旋切旋切旋切,激光等消除冠脉斑块器械激光等消除冠脉斑块器械激光等消除冠脉斑块器械激光等消除冠脉斑块器械Nair P,et al.Eurointerv.2006;2:363-370.Nair P,et al.Eurointerv.2006;2:363-370.Nair P,et al.Eurointerv.2006;2:363-370.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention研究年限研究年限手术例数手术例数穿孔发生率穿孔发生率总发生率总发生率POBA/Stent消斑器械消斑器械Ajluni,et al1988-199289320.4%0.14%1.1%Ellis,et al1990-1991129000.5%0.1%1.2%Dippel,et al1995-199962140.58%0.17%2.8%Gruberg,et al1990-1999307460.29%-1.2%Fukutomi,et al1992-199674430.93%0.41%0.86%Stankovic,et al1993-2001100140.84%0.48%1.8%Yu,et al1987-200028680.31%-Fasseas,et al1990-2001162980.58%0.25%1.18%Witzke,et al1995-2003126580.3%0.61%(PBOA)0.15%(Stent)1.0%Javaid，et al1996-2005385590.19%0.47%0.54%冠状动脉穿孔的发生率冠状动脉穿孔的发生率Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular Intervention不同介入方式冠脉穿孔发生率不同介入方式冠脉穿孔发生率介入措施介入措施发生率发生率PTCA/Stenting PTCA Stenting0.10.6%01.1%冠脉消斑器械冠脉消斑器械 MRA DCA TEC ELCA01.3%0.3 3.2%0 2.1%0.3 2.0%所有器械所有器械0.3 2.0%MRA=MRA=MRA=机械旋磨机械旋磨机械旋磨机械旋磨机械旋磨机械旋磨 DCA=DCA=DCA=定向旋切定向旋切定向旋切定向旋切定向旋切定向旋切 TEC=TEC=TEC=抽吸旋切抽吸旋切抽吸旋切抽吸旋切抽吸旋切抽吸旋切 ELCA=ELCA=ELCA=准分子激光成型术准分子激光成型术准分子激光成型术准分子激光成型术准分子激光成型术准分子激光成型术Fejka,M etal.Cardiovasc Rev Rep Fejka,M etal.Cardiovasc Rev Rep Fejka,M etal.Cardiovasc Rev Rep 200320032003;24(8):416-420.24(8):416-420.24(8):416-420.Complications of CatheterizationComplications of CatheterizationComplications of CatheterizationCardiovascular InterventionCardiovascular InterventionCardiovascular InterventionPCI时冠状动脉穿孔原因分析时冠状动脉穿孔原因分析Witzke CFWitzke CF，et al.et al.J Invasive Cardiol.2004,16(6):297-301J Invasive Cardiol.2004,16(6):297-3011995-20031995-20031995-2003年间，年间，年间，年间，年间，年间，126581265812658例患者，例患者，例患者，例患者，例患者，例患者，393939例发生冠状动脉穿孔例发生冠状动脉穿孔例发生冠状动脉穿孔例发生冠状动脉穿孔例发生冠状动脉穿孔例发生冠状动脉穿孔Complications of CatheterizationComplications of