《cto病变的技巧冠心病最新进展ppt课件》由会员分享，可在线阅读，更多相关《cto病变的技巧冠心病最新进展ppt课件（63页珍藏版）》请在金锄头文库上搜索。
1、慢性完全闭塞病变介入技巧和器械选择,北京安贞医院 吕树铮 教授,慢性完全闭塞病变介入技巧和器械选择,慢性完全闭塞病变的相关概念 慢性完全闭塞病变的病理结构和特点 CTO介入的导丝选择 CTO病变的支架选择,CTO的定义,闭塞时间大于3个月的病变,CTO病变形成时间的判断,AMI的时间 症状加重的时间 侧枝循环形成的多少及侧枝的直径,CTO病变长度的判断,顺行显影 逆行显影 双向造影,顺行显影,逆行显影,CTO病变的病理结构,1. 坏死脂核、胆固醇结晶及钙化,CTO病变的病理结构,2. 细胞外基质：胶原、钙化,CTO病变的病理结构,3. 微血管,CTO病变的类型,重度狭窄慢性闭塞轻中度狭窄慢性闭
2、塞,重度狭窄慢性闭塞,主要由纤维化和钙化的粥样硬化斑块组成 短闭塞段：纤维帽位于闭塞段的两侧边缘，中间为血管壁重塑形成的组织，闭塞时间一般为3个月以上，重塑的组织中含有大量的纤维组织 长闭塞段：常常有血栓的成分，闭塞段往往是纤维组织与血栓相间分布。这种病变导丝很难通过，成功率只有5070%,轻中度狭窄慢性闭塞,脂核,纤维组织,陈旧血栓,原有轻中度狭窄病变，班块破裂，未及时治疗，导致血管慢性闭塞，新的闭塞处远离原有狭窄斑块，导丝注意寻找闭塞斑块,CTO病变的病理特点,粥样斑块+钙化慢性发展融合而成,CTO病变的病理特点,斑块破溃形成血栓机化而成,CTO介入的导丝选择,导丝的结构,导引导丝的性能,
3、调节力：导丝尖端和中心钢丝结构 柔软性：导丝的直径、尖端结构和连接段变系程度 推送力：中心钢丝的硬度和中间变细方式 支持力：中心钢丝的直径和材料,处理CTO病变时常用的导丝,超滑导丝：如PT Graphic Intermediate、PT2、 Shinobi 、 Cross NT、Whisper等Coil型导丝：ACS Intermediate Standard、Cross IT100-400、Miracle3-12及Conquest (Pro)9-12等,处理CTO病变时常用导丝,超滑导丝,SCIMED PT2,The combination of a polymer cover and h
4、ydrophilic coating provides outstanding lubricity.,SCIMED PT Graphic Intermediate,Uni-body core with long, smooth taper from support region to tipHydrophilic-coated, polymer sleeve and tipIntermediate wire with slightly stiffer tipCrossing performance of polymer tip with visibility of spring tip,Ter
5、umo CrossNT,WHISPER Redefines Polymer Wire Performance,ResponsEase grind technology,DURASTEEL core material,Polymer Coated/ Hydrocoat Distal segment,Soft tip designed for frontline use,HI-TORQUE PILOT Design,HI-TORQUE PILOT Family Product Description,Design Highlights: Polymer-tip, hydrophilic Core-
6、to-tip with moderate support Graduated tip stiffness in the family Modified RESPONSEASE parabolic grind DURASTEEL core material Single lesion measurement marker,The HI-TORQUE PILOT family of guide wires offers a choice of wires that vary in tip stiffness to address a wide variety of lesion morpholog
7、y.,Tip coils beneath the polymer help facilitate tip shaping.,Modified RESPONSEASE Parabolic Grind This modified RESPONSEASE design provides additional support, excellent torque transmission and in-lesion tip control.,The HI-TORQUE PILOT guide wires maintained their tip shape better than competitive
8、 wires after passing through a tortuous path model.,The DURASTEEL core material of the HI-TORQUE PILOT family is stronger than conventional stainless steel for improved core strength and tip shape retention. DURASTEEL withstands more pulling force than regular 304v stainless steel.,.007” Corewire Su
9、pport,PTFE 喷涂 近端 黑色的PTFE 袖套延伸至远端头部,平的显影线圈,Shinobi & Shinobi Plus,.010” Corewire support,SHINOBI Plus,SHINOBI,WIZDOM 的核心钢丝,STABILIZER Plus 的核心钢丝,处理CTO病变时常用的导丝,Coil型导丝,ACS Intermediate & Standard, Intermediate：中软缠绕头端，core-to-tip，锥行渐变的中间轴, Standard：标准缠绕头端，不易扭曲的推送杆,ACS导丝,A Guide to ACS HI-TORQUE Guide W
10、ires,Cross IT,Cross IT 100-400,Cross IT特性,Smooth Shaft with Fluororesin coating,Jointless Spring Coil,Property of ASAHI NEOS PTCA GUIDEWIRE Family,With the uni body core which is precisely tapered up to the extreme end, without additional ribbon, thus highly good torqueability is achieved.,Shaft has
11、 fluororesin coating, which provides high operativity and good matching with balloon catheter.,One Piece Core Wire,Jointless spring coil made of two different metals provides good torqueability and excellent slide property with devices,Medical Grade Silicone Coating,Jointless Spring Coil structure i
12、mage,Soft / Soft AG141000 Radio-opacity 3cm Coil 30 cm Diameter 0.014inch Length 175cm,This is a first choice guidewire with high torque response and excellent steerability because of the unique core property.（Tip load 0.7G）,Intermediate / Medium AG142000 Radio-opacity 3cm Coil 30 cm Diameter 0.014i
13、nch Length 175cm,This is a guidewire with a good balance of tip flexibility and support performance.（Tip load 3.0G）,Standard / Standard AG143000 Radio-opacity 3cm Coil 30 cm Diameter 0.014inch Length 175cm,Improved tip stiffness with our unique core taper design.（Tip load 6.5G）,Light / Light AG14500
14、0 Radio-opacity 3cm Coil 20cm Diameter 0.014inch Length 175cm,ASAHI NEOS PTCA Guide Wire Line-up,Improved lubricity and good tip shape memory with our unique core design. Excellent torque response. This wire has a flexible tip and can be used as a first choice wire for almost all procedures.（Tip loa
15、d 0.5G）,（Tip load 3.0G）,Miracle4.5 / Miraclebros4.5 AG14M045 Radio-opacity 11cm Coil 11 cm Diameter 0.014inch Length 175cm,（Tip load 4.5G）,Miracle6 / Miraclebros6 AG14M060 Radio-opacity 11cm Coil 11 cm Diameter 0.014inch Length 175cm,（Tip load 6.0G）,Miracle12 / Miraclebros12 AG14M070 Radio-opacity 1
16、1cm Coil 11cm Diameter 0.014inch Length 175cm,（Tip load 12.0G）,Miracle3 / Miraclebros3 AG14M050 Radio-opacity 11cm Coil 11cm Diameter 0.014inch Length 175cm,Miracle Series Applying the structure which further improves torque performance for CTO use. The tip part has the structure which is difficult to be trapped by the lesions.,Structure of Conquest Pro/Pro12,AGH143090 Conquest Pro,Grand Slam / Grand Slam AG141002 Radio-opacity 4cm Coil 4cm Diameter 0.014inch Length 175cm,
