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1、冠状动脉介入治疗球囊的选择Stillwatersrundeep.流静水深流静水深,人静心深人静心深Wherethereislife,thereishope。有生命必有希望。有生命必有希望球囊分类球囊分类n n整体交换球囊（OTW-overthewire)n n快速交换球囊(monorail)Rapid ExchangeRapid ExchangeGuidewireGuidewireInflation lumenInflation lumen& guidewire lumen& guidewire lumenInflation lumen onlyInflation lumen onlyInfl
2、ation portInflation portOver-the-WireOver-the-WireGuidewireGuidewireInflation lumenInflation lumen& guidewire lumen& guidewire lumenInflation PortInflation Port球囊的结构球囊的结构n n球囊尖端n n球囊n n推送杆球囊尖端球囊尖端n n外径：直头圆弧锥形n n尖端与球囊的连接：胶水黏结热焊接激光焊接球囊球囊n n球囊材料：尼龙、聚乙烯球囊顺应性（顺应性球囊材料：尼龙、聚乙烯球囊顺应性（顺应性/ /半顺应半顺应性性/ /非顺应性）（顺应
3、性非顺应性）（顺应性= =球囊直径球囊直径/ /压力压力atmatm）n n折叠方式：零折叠、二折叠三层折叠：利于回卷，后撤，折叠方式：零折叠、二折叠三层折叠：利于回卷，后撤，低折叠减小通过半径。低折叠减小通过半径。n n标记方式：中央标记易于通过严重狭窄病变，双标记标记方式：中央标记易于通过严重狭窄病变，双标记利于测量病变长度，与内杆关系（外包利于测量病变长度，与内杆关系（外包/ /内嵌）内嵌）n n球囊肩部角度：球囊于尖部平滑过渡有利于通过病变球囊肩部角度：球囊于尖部平滑过渡有利于通过病变n n球囊与中心杆的连接技术和材料：决定通过扭曲血管的能球囊与中心杆的连接技术和材料：决定通过扭曲血管
4、的能力力n n球囊表面亲水涂层有利球囊的通过性。球囊表面亲水涂层有利球囊的通过性。开辟新纪元的零折叠技术零折叠零折叠两折叠两折叠没有折叠的球囊材料没有折叠的球囊材料球囊材料直接裹在远端球囊杆上，加压充盈球囊材料直接裹在远端球囊杆上，加压充盈 成为一个球囊成为一个球囊Sprinter 1.5mmSprinter Legend 1.25&1.5mm 金标记带在外杆上金标记带在外杆上标记带处的球囊外径在同类产品中最小（标记带处的球囊外径在同类产品中最小（0.024”）SprinterLegend1.25&1.5mm球囊标记带改放在球囊内杆上铂金加銥标记带在内杆上铂金加銥标记带在内杆上球囊性能球囊性能
5、n n外径（crossingprofile)n n灵活性（flexibility)n n跟踪性（trackbility)n n推送性（pushbility)n n顺应性（compliance)球囊操作要领球囊操作要领预扩张预扩张n n有利于支架的植入有利于支架的植入n n有利于病变的测量有利于病变的测量n n选择小于血管直径选择小于血管直径0.5-1mm0.5-1mm的球囊进行预扩张，球囊长度的球囊进行预扩张，球囊长度应适当应适当n n预扩张应尽量减少对正常血管的损伤，因此，大直径高压预扩张应尽量减少对正常血管的损伤，因此，大直径高压力只在必要时使用。力只在必要时使用。n n为测量病变长度，使
6、预扩张球囊在冠状动脉内进行造影时，为测量病变长度，使预扩张球囊在冠状动脉内进行造影时，注射造影剂的力度不宜过大，以免加重血管的撕裂注射造影剂的力度不宜过大，以免加重血管的撕裂n n对于狭窄程度重、较复杂的病变，预计支架通过较困难的对于狭窄程度重、较复杂的病变，预计支架通过较困难的病变应常规充分地预扩张，尤其对初学者病变应常规充分地预扩张，尤其对初学者预扩张中的问题预扩张中的问题n n球囊的通过性：严重的狭窄、钙化病变，闭塞病变（球囊选择、双导丝、锚定、Tornus、旋磨)。n n球囊的扩张效果：钙化病变，较硬纤维斑块（切割、旋磨、双导丝+高压囊）。血管内超声（IVUS）: 血管钙化不同类型病变
7、的球囊选择 n n小血管病变：宜选用外形小，推进性好的球囊。还可选用耐高压球囊。n n扭曲病变：应选择外形较小、推进性好的球囊。OTW球囊推进性较单轨球囊好，还有利于交换导丝n n钙化病变：应选择外形较小、推进性好的球囊。还可选用双导丝、耐高压乳突或切割球囊，两根导丝加高压球囊，旋磨后球囊扩张。后扩张后扩张n n防止支架贴壁不良，预防支架内血栓形成，降低再狭窄n n后扩张球囊可选择大一号的球囊或更高的压力n n后扩张时一定不能超出支架的边缘，尤其是的DESn n不可盲目追求所有病例的大球囊高压力的后扩张，以免增加无再流和冠状动脉破裂的风险不同类型病变的球囊选择 n nCTO病变：常选择单标记、
8、整体交换、小外径（1.5-1.25-1.0mm）球囊，如MaverickSprinter Legend等n n长病变：原则上选用较长的球囊，以防两端撕裂并减少扩张次数。n n分叉病变：可选双导丝球囊、切割球囊。目的：减少斑块移位、降低分支闭塞的概率。常用的球囊特点常用的球囊特点Maverick PTCA Balloon Cathetersn nProprietarylaserbondedtechnologycreatesanextraordinaryTrakTipDesignandprecise,smoothbondsthroughouttheshaft.n nPushcoildesignan
9、dimproveddistalflexibilityforenhancedtrackability.n nOur1.5and2.0mmSoftLEAPBalloonsofferenhancedcrossability.Apex PTCA Dilatation Cathetern nSlopeOuterShaftsmoothlytransitionsSlopeOuterShaftsmoothlytransitionsfromstifftoflexible,allinonepiece,forfromstifftoflexible,allinonepiece,formoreefficientpush
10、transmissionmoreefficientpushtransmissionn nBi-SegmentInnerShaftoptimizestheBi-SegmentInnerShaftoptimizesthebalancebetweenpushandtrackbalancebetweenpushandtrackn nShorter,thinnermarkerbandsincreaseShorter,thinnermarkerbandsincreasedistalflexibilitydistalflexibilityn nRedesignedtipwithimprovedflexibi
11、lityandRedesignedtipwithimprovedflexibilityandwiremovement;sameultra-low0.017profilewiremovement;sameultra-low0.017profilen nOptiLEAPBalloonwithreducedwaistOptiLEAPBalloonwithreducedwaistthicknessprovidesgreatsizingflexibilitywiththicknessprovidesgreatsizingflexibilitywithlowerprofileslowerprofilesn
12、 nNano-compositematerialsaddsstructureandNano-compositematerialsaddsstructureandpushabilitytotheoutershaftpushabilitytotheoutershaftQuantum Maverick Balloonn nLowprofile,fulllength1.8For2.0FMonorailshaftn nLowprofile3.2Fproximalover-the-wireshaftn nBioslideCoatingonaPEBAXDistalShaftn nLaserbondingte
13、chnologyn nQuantumLEAPBalloonMaterialn nTaperedTrakTipDesignwith.017lesionentryprofile*NC sprintern n外形细小的外形细小的FasTracFasTrac头端技术头端技术- -可在遇到可在遇到较难通过的病变时提供极佳的通过能力；较难通过的病变时提供极佳的通过能力； n n柔软耐用的柔软耐用的FulcrumPlusFulcrumPlus球囊材料和球囊材料和MiniWrapMiniWrap折叠技术提供细小的外径和出色的再回抱能力；折叠技术提供细小的外径和出色的再回抱能力； n n 选择性的选择性的Dur
14、a-TracDura-Trac涂层使球囊在到达和通过涂层使球囊在到达和通过病变的过程中保持持久的润滑，在球囊扩张病变的过程中保持持久的润滑，在球囊扩张时保持稳定；时保持稳定； n n 渐细钢丝设计的推送杆增强了球囊的跟踪能渐细钢丝设计的推送杆增强了球囊的跟踪能力和通过远端病变能力；力和通过远端病变能力； n n 光滑细小的导丝交换口使光滑细小的导丝交换口使3.5mm3.5mm以下的任何以下的任何两个球囊可在两个球囊可在6F6F（0.0700.070）的指引导管里对吻。）的指引导管里对吻。n nSunflex Tip is superbly engineered to give a Sunfle
15、x Tip is superbly engineered to give a perfect balance between flexibility and kink resistance. perfect balance between flexibility and kink resistance. Zero transition between the tip and wire for smoothest Zero transition between the tip and wire for smoothest entry profile. entry profile.n nTaper
16、ed Tip:The tapered soft tip combined with Tapered Tip:The tapered soft tip combined with advanced laser welding technology provides the advanced laser welding technology provides the most competitive tip profile most competitive tip profilen nSlidematrix dual coating is specially formulated withSlid
17、ematrix dual coating is specially formulated with two unique proprietary blends. Hydrophilic and Invio two unique proprietary blends. Hydrophilic and Invio coatings are applied to the distal leading tip section coatings are applied to the distal leading tip section and the balloon/shaft section, res
18、pectively to provide and the balloon/shaft section, respectively to provide an optimal balance between lubricious crossing and an optimal balance between lubricious crossing and minimizing watermelon seeding minimizing watermelon seeding n nTight Fold processing results in a slenderTight Fold proces
19、sing results in a slender primary profile for enhanced crossability primary profile for enhanced crossability through tight lesions. through tight lesions. n nSapphire NCSapphire NCOrbusNeich n nThe IP Transition Zone of the Avita The IP Transition Zone of the Avita PTCA Dilatation Catheter provides
20、 PTCA Dilatation Catheter provides intensified pushability. intensified pushability. n nThe new tapered tip design with soft The new tapered tip design with soft material exhibits a flexible tip for smooth material exhibits a flexible tip for smooth lesion entry and minimal vessel trauma. lesion ent
21、ry and minimal vessel trauma. n nThe Invio coating on the inner lumen The Invio coating on the inner lumen eliminates friction between the catheter eliminates friction between the catheter and guidewire. Invio is also applied to and guidewire. Invio is also applied to the outer distal segment from t
22、he tip the outer distal segment from the tip to the exit marker zone for lubricious to the exit marker zone for lubricious crossability. crossability. n nAvita HPAvita HPOrbusNeich Ruginn nCrossTipTM CrossTipTM 确保确保RyuginRyugin通过性可以达到的最高性能。通过性可以达到的最高性能。CrossTipTMCrossTipTM是是由特殊混合的弹性塑料聚合物制作而成。由特殊混合的弹
23、性塑料聚合物制作而成。0.0170.017英寸英寸(0.043(0.043毫米毫米) )的入的入口外径确保了口外径确保了RyuginRyugin在完全闭塞的病变的复杂管腔里的通过性。在完全闭塞的病变的复杂管腔里的通过性。CrossTipTMCrossTipTM中等长度的柔韧前端能较易地通过移植支架处的病变并中等长度的柔韧前端能较易地通过移植支架处的病变并绷紧其钙化病变。绷紧其钙化病变。 n n亲水涂层亲水涂层亲水涂层亲水涂层M-CoatingM-Coating，塑料聚合物的复合层和新一代金属合金的，塑料聚合物的复合层和新一代金属合金的HypotubeHypotube。使用。使用RyuginRy
24、ugin通过过度弯曲和大弯曲血管时，它能顺滑的到通过过度弯曲和大弯曲血管时，它能顺滑的到达目标病变部位，并且成功的处理其复杂闭塞病变。达目标病变部位，并且成功的处理其复杂闭塞病变。n n提供广泛有效的球囊直径选择范围提供广泛有效的球囊直径选择范围从超细的从超细的1.251.25毫米直径到毫米直径到4.04.0毫米毫米直径不等。直径不等。n n薄型聚酰胺球囊薄型聚酰胺球囊薄型聚酰胺球囊薄型聚酰胺球囊确保了其卓越的通过性确保了其卓越的通过性RyuginCrossTipRyuginCrossTip是从尖端到薄是从尖端到薄型聚合物球囊的一段平滑过度部分，平滑柔韧的联合体能够通过各种型聚合物球囊的一段平
25、滑过度部分，平滑柔韧的联合体能够通过各种复杂病变部位。复杂病变部位。n n泰尔茂新一代泰尔茂新一代泰尔茂新一代泰尔茂新一代FC(Flexible Corrugate) FC(Flexible Corrugate) 轴管轴管轴管轴管成为连接高弹性的前端轴管成为连接高弹性的前端轴管和具备强硬金属的和具备强硬金属的HypotubeHypotube轴管之间的桥梁。轴管之间的桥梁。FC-shaftFC-shaft是指经过加是指经过加工的柔软的胶质轴，该技术实现了通过一个平衡轴加强力量的传输性工的柔软的胶质轴，该技术实现了通过一个平衡轴加强力量的传输性和弹性。和弹性。 Voyagern nSuperb C
26、ross Tapered Tip DesignSuperb Cross Tapered Tip Design1. 1.Newtaperedtipwith.017”tipentryprofiledesignedtocrosstightlesionsNewtaperedtipwith.017”tipentryprofiledesignedtocrosstightlesions2. 2.Improvedtip-to-wireconformability1forconfidenttrackandcrossImprovedtip-to-wireconformability1forconfidenttra
27、ckandcross3. 3.PolyurethanetipmaterialisflexibleyetdurablefortoughlesionsPolyurethanetipmaterialisflexibleyetdurablefortoughlesions4. 4.FlexibletungstenmarkertechnologyallowscathetertoconformtotortuousanatomyFlexibletungstenmarkertechnologyallowscathetertoconformtotortuousanatomyn nMore Options Low
28、Profile Shaft DesignMore Options Low Profile Shaft Design1. 1.Versatiletreatmentina6FguideVersatiletreatmentina6Fguide2. 2.ExcellenttrackandpushintortuousanatomywithnewhypotubedesignExcellenttrackandpushintortuousanatomywithnewhypotubedesign3. 3.Reinforcedmid-shaftdesignprovidesflexibilityandadditio
29、nalsupportReinforcedmid-shaftdesignprovidesflexibilityandadditionalsupportn nFlexibility with Visibility Proprietary Tungsten MarkerFlexibility with Visibility Proprietary Tungsten Marker1. 1.NewmarkermaterialcomprisedoftungstenpolymerNewmarkermaterialcomprisedoftungstenpolymer2. 2.Flexiblemarkerdes
30、ignallowsthecathetertoconformmoreeasilytotortuousanatomyFlexiblemarkerdesignallowsthecathetertoconformmoreeasilytotortuousanatomy3. 3.IncreasedmarkerflexibilityhelpstoreduceresistancewhencrossingtightlesionsIncreasedmarkerflexibilityhelpstoreduceresistancewhencrossingtightlesionsn nPrecise Dilatatio
31、n Proven Balloon PerformancePrecise Dilatation Proven Balloon Performance1. 1.ShorttapersallowforprecisedilatationShorttapersallowforprecisedilatation2. 2.ImprovedLOFOLDBalloonTechnologyprocessesallowsforexcellentrewrapandrecross1ImprovedLOFOLDBalloonTechnologyprocessesallowsforexcellentrewrapandrec
32、ross13. 3.XCELONSBalloonMaterialachievessuperbflexibilityXCELONSBalloonMaterialachievessuperbflexibilityPowersailn nPLATEAU Balloon MaterialPLATEAU Balloon Material1. 1.Providesnon-complianceathighpressurewithoutcompromisingProvidesnon-complianceathighpressurewithoutcompromisingperformanceperformanc
33、e2. 2.FlexibilityandconformabilityforexcellentdeliverabilityFlexibilityandconformabilityforexcellentdeliverabilityn nLOFOLD Balloon TechnologyLOFOLD Balloon Technology1. 1.ProvidesalowcrossingprofileforexceptionallesioncrossProvidesalowcrossingprofileforexceptionallesioncross2. 2.LOFOLDballoontechno
34、logyforimprovedballoonrewrapLOFOLDballoontechnologyforimprovedballoonrewrapn nSoft Tip DesignSoft Tip Design1. 1.Taperedtipdesigncreatesalowentryprofileandexcellenttip-to-wireTaperedtipdesigncreatesalowentryprofileandexcellenttip-to-wireconformabilityforeasylesionaccessconformabilityforeasylesionacc
35、ess2. 2.SofttipprovidesflexibilityfornegotiatingtortuosityandcrossingstentSofttipprovidesflexibilityfornegotiatingtortuosityandcrossingstentstrutsstrutsn nDual Swaged MarkersDual Swaged Markers1. 1.ProvidelowerprofilesthanconventionalmarkersProvidelowerprofilesthanconventionalmarkers为复杂病变设计的为复杂病变设计的
36、MINI TREKn nMINITREK独特的小底盘设计提供提供1.20 mm, 1.50 mm和和2.00 mm 的球囊的球囊n nSafeCut uses dual wire mechanism to createSafeCut uses dual wire mechanism to create focused force. It has a built-in 0.011 integral focused force. It has a built-in 0.011 integral wire external to the balloon to help track wire exte
37、rnal to the balloon to help track tortuous vessels with great efficiency. tortuous vessels with great efficiency. n nA standard 0.014 guidewire that delivers the A standard 0.014 guidewire that delivers the catheter to the target lesion also participates catheter to the target lesion also participat
38、es in the dilatation process. The guidewire exit in the dilatation process. The guidewire exit port is located at the proximal part of the balloon. port is located at the proximal part of the balloon. n nDuring balloon dilatation, the standard guidewire and integral wire apply controlled During ball
39、oon dilatation, the standard guidewire and integral wire apply controlled force to facilitate plaque fractures at low inflation pressures. The same application also force to facilitate plaque fractures at low inflation pressures. The same application also helps minimize balloon slippage. helps minim
40、ize balloon slippage. n nSafeCuts distal leading tip profile is 0.032 tapered to 0.028 which is smaller than SafeCuts distal leading tip profile is 0.032 tapered to 0.028 which is smaller than those of other focused force balloons. those of other focused force balloons. n nBalloons with embedded bla
41、des for scoring the vessel have high crossing profiles due to Balloons with embedded blades for scoring the vessel have high crossing profiles due to the nature of the balloon materials and blades. the nature of the balloon materials and blades. n nThe integral wire and standard guidewire apply even
42、ly distributed force to facilitate The integral wire and standard guidewire apply evenly distributed force to facilitate controlled plaque at low pressures, reducing trauma to the vessel wall. controlled plaque at low pressures, reducing trauma to the vessel wall. n nOther balloons using the same fo
43、cused force technology use blades which are much more Other balloons using the same focused force technology use blades which are much more traumatic to the vessel wall. traumatic to the vessel wall. OrbusNeich Cutting Balloonn nThe Flexibility You WantThe Flexibility You Want 1. 1.Nylonballoonmater
44、ialdesignedtoprovideflexibility,superbNylonballoonmaterialdesignedtoprovideflexibility,superbcomplianceandimprovedpunctureresistancecomplianceandimprovedpunctureresistance1. 1.Overallbetterdeliverabilitytotreatmorecomplexlesions.Overallbetterdeliverabilitytotreatmorecomplexlesions.n nThe Deliverabil
45、ity You NeedThe Deliverability You Need 1. 1.30%moreDeliverablethantheCuttingBalloonUltra2Device*30%moreDeliverablethantheCuttingBalloonUltra2Device*2. 2.50%improvementinre-crosscomparedtotheCuttingBalloonUltra250%improvementinre-crosscomparedtotheCuttingBalloonUltra2Device*Device*n nThe Predictabil
46、ity You Rely OnThe Predictability You Rely On 1. 1.PrecisedilatationPrecisedilatation2. 2.ScoringtheplaquebyseveringtheelasticandfibroticcontinuityoftheScoringtheplaquebyseveringtheelasticandfibroticcontinuityofthevesselwallvesselwall3. 3.DilatingthelesionatlowerpressureswithlessrecoilDilatingthelesionatlowerpressureswithlessrecoil4. 4.LumengainthroughplaquecompressioninsteadofvesselwallexpansionLumengainthroughplaquecompressioninsteadofvesselwallexpansion谢谢谢谢
