1040_Sharma.pdf

《1040_Sharma.pdf》由会员分享，可在线阅读，更多相关《1040_Sharma.pdf（20页珍藏版）》请在三个皮匠报告上搜索。

1、Approach to ISR:Device Selection and AlgorithmRaman Sharma,MD,FACC,RPVIAssistant Director of Endovascular Interventions ProgramAssistant Professor of Medicine,Division of CardiologyNYEVS 2025Financial Disclosures NoneBackground1.Gerhard-Herman M,et al.Circulation.2017;135:e686-e7252.Tosaka A,et al.J

2、 Am Coll Card.2012;59:16-233.Singh G,et al.J Card Surg.2014;55:325-333Wide variety of combinations of PTA,atherectomy,DCB,DES and BMS have allowed for a dramatic reduction in the rates of surgical bypass procedures for peripheral arterial disease 1996-2011 Medicare population experienced 165%increas

3、e in endovascular interventions and corresponding 61%decrease in bypass surgery130-40%of patients will experience ISR within 2 years of the incident procedure2-3PathophysiologyPTA w/wo stenting results in vessel wall traumaRemoval of endotheliumRupture of internal elastic lamina/medial injuryVessel

4、recoil,negative remodeling and neointimal hyperplasiaComplex new restenotic lesion that is morphologically distinct from a denovo lesionPathophysiologyPathophysiology:Thrombus FormationNarula,N.et al.J Am Coll Cardiol.2018;72(18):2152-63Pathophysiology:Thrombus FormationThrombus Formation6Secondary

5、Thrombotic EventsLimb Events Acute Limb IschemiaMajor AmputationLimb RevascularizationSymptom ProgressionABI/TBI ChangeCardiovascular EventsMyocardial InfarctionCardiovascular DeathHeart Failure Jones S,et al.Antithrombotic Therapy in Peripheral Artery Disease:Generating and Translating Evidence Int

6、o PracticeClinical Significance and OutcomesTosaka A,et al.J Am Coll Card.2012;59:16-23Is The Answer In the Filter?Filter debris underwent core lab histologic analysis PTA,stent,atherectomy,aspiration used Majority of thrombus containing did not appear thrombotic angiographically