"It's so weak!" Director Miao said contemptuously while wiping the sweat in his palm on his pants.

Zhang You accurately saw Director Miao’s actions of wiping sweat, and thought to himself that you were not as nervous as you were.

"The most difficult part of classic Crush technology is kiss expansion. This step determines the patient's recovery after surgery." Director Miao seemed to have not noticed his small movements at all and continued to whisper, "I have seen several classic Crush surgeries in circulatory intervention, and the kiss expansion is really uneven."

"Director Miao, I don't understand." Zhang You first said that he didn't understand, and admitted nonsense to avoid misunderstandings from his words.

"What's wrong?"

"The classic Crush technology has not been carried out in our hospital's circulatory interventional surgery. I studied it for a day yesterday and felt that the guide wire was penetrated into the mesh of the stent. I dare not think about how this operation was done."

Zhang You smiled embarrassedly, his big teeth bared, a little dazzling.

At that time, he didn't think it was difficult to penetrate the mesh of the 18th guide wire at all, but he didn't expect it to be so difficult, which was what he just felt.

"But the last step of dilating kiss is not that difficult. The branched blood vessels and the two balloons in the main trunk expand together, suppressing the titanium-nickel alloy stent and trying to stick to the blood vessel wall of the main trunk. This... seems very simple."

After hesitating for a while, Zhang You still asked his question.

"Accurate wire guide technology is just one of the key points, and it is the first one." Director Miao whispered to Zhang You when the surgeon was slowly working.

"The side-branch balloon is usually difficult to enter, so it should be sent to the side-branch balloon first; sometimes in order to increase support, it can also be sent to the main balloon first, and even after the main balloon is in place, it can be appropriately pressurized to increase support and then push the side-branch balloon.

However, attention should be paid to avoid forcibly pushing the bracket to deform and destroy it. When pushing the balloon, if resistance is encountered, the most common reason is wire entanglement..."

Speaking of technical details, Zhang You suddenly found that Director Miao seemed to have a deep study of this technology, not as he said, never dabbled in it.

For example, forced push causes deformation and damage to the bracket, which is difficult to say in textbooks and in communication with peers.

And once the bracket is deformed and damaged, it will be difficult to remove it again.

These are all bloody clinical experiences and lessons. Has Director Miao performed a classic crush surgery? Or is it that their hospital conducted a crush surgery and did it, and Director Miao went to save the fire.

"This is just the beginning, it's hard." Director Miao asked in a low voice as he looked at the movements of the craftsman on the screen.

"Uh..." Zhang You was stunned.

Such a complicated thing or just the beginning?

"When the balloon is finally dilated, the proximal marks of the two balloons are aligned, and the overlapping part should be shorter, located above the vascular ridge, facing the "iliac" of the bifurcation of the blood vessel, or equivalent to the POC area.

If the diameter of the two branched blood vessels is significantly smaller than the diameter of the mother blood vessel, the position of the dilated balloon can be moved higher, and the double balloons can be used to make the female blood vessel segment stent fully adhered to the wall."

"The technical details here are too difficult, and I don't know what to do." As he said, Director Miao sighed, "The doctors who are involved in our hospital are average and are planning to study in the United States next year."

"..." Zhang You was speechless. Technical details are the most important. The devil is in the details. This sentence is right.

I felt that I could do it after the operation, but I caught a lot of people who didn’t know how to do it after the operation.

This is common in surgery.

"Every balloon is in, the next technical point is the balloon expansion time.

Because the non-compliant balloon filling time is not good for expansion within a time of less than 10 seconds, I think the filling peak pressure will last for at least 10-15 seconds when the balloon expands to the kiss."

"Then the next technical detail is the balloon expansion speed, which is not as fast as possible, nor as slow as possible, but... I feel it's better to be a little slower.

As for the technique without special requirements, the pressure filling speed of the balloon should be as slow as possible, especially when choosing a balloon with a large diameter, this can reduce the risk of blood vessel rupture."

Director Miao's voice was a little dull, but Zhang You's heartbeat suddenly accelerated.

A light and fluent sentence, I don’t know how many patients are hiding behind the scenes of coronary rupture during the classic crush procedure.

Once an accident occurs, an emergency heart bypass is bound to be necessary.

From this point of view, Director Miao may not have had a classic crush surgery. It may have been because he wiped his butt too much for the circulatory department, which has caused a psychological shadow.

After seeing too much, Director Miao from Lianzhi Surgery has his own experience.

It’s really not easy to say that the director of the imperial capital is. You can find out the tricks in just a few glances. It’s amazing!

Zhang You sighed and admired.

"The most important thing is to try to fill the balloon synchronously, and be sure to synchronize the decompression balloon. Asynchronous decompression may cause the bifurcation ridge to shift, resulting in the first decompression of the branch opening."

"Synchronous, do you know how difficult this is?"

Director Miao stared at the operation of the surgeon on the screen, his voice getting smaller and smaller, and he was more and more focused.

Although he used questions, he didn't expect to get the answer at all.

Although Zhang You is old, his memory has never been bad. With yesterday's research, he has many questions in his mind. Director Miao's words have given him more understanding and understanding of crush technology.

The operation of the on-screen operator confirms to some extent the words of Director Miao.

Whether it is the balloon position, squeeze time, squeeze pressure or synchronization, it is done well.

Although Director Miao said that this step was difficult, Zhang You only watched the operation once and could not understand how difficult it was.

In the Great Hall, there would occasionally be unconscious heavy breathing sounds, and the doctors present watched the operator's operation intently.

Sure enough, just as Director Miao introduced, kissing operation takes much longer than the guidewire penetrating the mesh of the stent.

The craftsman is cautious in every step, just like walking on thin ice.

However, the surgeon's surgery was very good. He operated the guidewire, catheter, balloon, and stent. Every step was clean and neat. Although each step was not fast, it was clearly distinguished.

The double balloons squeeze the kiss, and the stent on the screen, which is ridged in the middle of the trunk can be seen on the naked eye, and it is suppressed to fit the blood vessel wall as much as possible.

Zhang You suddenly understood why Dr. Miyamoto wanted to join forces with Abbott and worked hard to get some drug-eluting stents.

No matter how perfect the kiss is, the bracket has its own volume.

The stent that is compressed and adheres to the wall is equivalent to a narrowing. Coupled with the characteristics of the stent itself, it will definitely lead to hemodynamic changes in the blood vessels.

In other words, this position is particularly prone to blockage, stent thrombosis, and restenosis of the edge branch vessels.

As the name suggests, a drug-eluting stent is a drug that can be slowly released on the inner membrane of the stent. This is how Zhang You understands it.

Under the direct action of the drug, the chance of intrastent thrombosis and restenosis of the side branch blood vessels can be delayed, and even if it is not good, it will delay more or less for several months.

With the pursuit of technology to a certain extent, it is extremely difficult to go further.

I think Dr. Miyamoto has reached the pinnacle of crush technology, but he cannot avoid the occurrence of these complications. He can only seek another change - material science support.

Awesome!

Zhang You gradually understood the operation and also understood why Director Miao and the circulatory physicians around him were so fanatical and nervous.

Four words gradually appeared in his mind - reaching the pinnacle.

There is nothing to change in one procedure, but the postoperative effect of clinical surgery is not very ideal. Countless doctors have conducted continuous research and improvement.

If one direction doesn’t work, change to another. To some extent, there is no difference between Dr. Miyamoto and Mr. Huang.

Mr. Huang directly improved the surgery, while Dr. Miyamoto was seeking changes in materials science, but no matter whether it was successful or not, there was only one goal - to make the surgery more ideal and extend the patient's postoperative survival time.

The public demonstration surgery at this annual meeting allowed everyone to learn crush technology only on one hand, but more importantly on displaying drug-eluting stents.

Zhang You thought a lot, and his eyes were cast on Dr. Miyamoto in the front row, and saw Dr. Miyamoto whispering to his assistant to comment on the surgeon's operation.

The operation performed by Director Xue did not attract Dr. Miyamoto's attention. He chatted with his assistant easily. Zhang You really wanted to come over and listen to what Dr. Miyamoto was saying, and he became more and more curious.

However, Zhang You was stunned for a flash of thought.

Since Crush appeared to be the word "classic", his technique has been tried and done, and it is perfect.

Some problems that cannot be solved are not the operator's business. They are inherent shortcomings of the surgical procedure and can only be compensated by materials technology.

It is extremely difficult to change one of the key points of this technique, just like the fixed pattern in Go.

Each step of the fixed formula has undergone thousands of drills, indicating that this is the most reasonable step and the optimal solution.

Huang Lao wants to change the fixed pattern?!

Anyway, Zhang You thought he would not have such an idea. Mr. Huang... might be just a confused and delusional one.

As for the successful operation in 912 in the past few days, Zhang You also thinks it is a rumor.

If you want to change the surgical style, it is like a national Go player who wants to change the fixed style, which is simply impossible!

Unless it is a fixed pattern like a large avalanche.

But the classic crush technology is not difficult to understand. The difficulty lies in the operation and the retention of the stent in the main blood vessels.

Want to change?

Impossible.

Zhang You suddenly sighed.

"Director Zhang, what's wrong?" Director Miao looked at the operation on the screen and asked absent-mindedly.

"I don't think it's necessary for Mr. Huang and Zhou Congwen to have a surgical demonstration next. Director Xue's surgery... I don't think there is anything to change. If you have to say something, it's just some techniques and details." Zhang You said the truth.

"..." Director Miao was stunned, his lips moved, but he said nothing and remained silent.

yes.

The classic Crush technology is almost perfect. How is Huang Lao planning to change this hellish technique?

This is simply impossible.

Director Miao once put himself in, but in the end he still felt that Dr. Miyamoto's approach was right.
To be continued...