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1、冠状动脉介入治疗球冠状动脉介入治疗球囊的选择囊的选择徐州中心医院吴强球囊分类球囊分类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 onlyInflation portInflation portOver-the-WireOver-the-WireGuidewireG
2、uidewireInflation lumenInflation lumen& guidewire lumen& guidewire lumenInflation PortInflation Port球囊的构造球囊的构造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尖端与球囊的衔接：胶水黏结热焊接激光焊接球囊球囊n n球囊资料：尼龙、聚乙烯球囊顺应性顺应性球囊资料：尼龙、聚乙烯球囊顺应性顺应性/ /半顺应半顺应性性/ /非顺应性顺应性非顺应性顺应性= =球囊直径球囊直径/ /压力压力atmatmn 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
3、：零折叠、二折叠三层折叠：利于回卷，后撤，低折叠减小经过半径。低折叠减小经过半径。n n标志方式：中央标志易于经过严重狭窄病变，双标志标志方式：中央标志易于经过严重狭窄病变，双标志利于丈量病变长度，与内杆关系外包利于丈量病变长度，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经过病变球囊肩部角度：球囊于尖部平滑过渡有利于经过病变n n球囊与中心杆的衔接技术和资料：决议经过扭曲血管的才球囊与中心杆的衔接技术和资料：决议经过扭曲血管的才干干n n球囊外表亲水涂层有利球囊的经过性。球囊外表亲水涂层有利球囊的经过性。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
4、资料没有折叠的球囊资料球囊资料直接裹在远端球囊杆上，加压充盈球囊资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Sprinter1.5mmSprinterLegend1.25&1.5mm金金标志志带在外杆上在外杆上标志带处的球囊外径在同类产品中最小标志带处的球囊外径在同类产品中最小0.024SprinterLegend1.25&1.5mm球囊标志带改放在球囊内杆上铂金加銥金加銥标志志带在内杆上在内杆上球囊性能球囊性能n n外径crossingprofile)n n灵敏性flexibility)n n跟踪性trackbility)n n推送性pushbility)n n顺应性comp
5、liance)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有利于病变的丈量有利于病变的丈量n n选择小于血管直径选择小于血管直径0.5-1mm0.5-1mm的球囊进展预扩张，球囊长度的球囊进展预扩张，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运用。力只在必要时运用。n n为丈量病变长度，使预扩张球囊在冠状动脉内进展造影时，为丈量病变长度，使预扩张球囊在冠状动脉内进展造影时，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
6、n对于狭窄程度重、较复杂的病变，估计支架经过较困难的对于狭窄程度重、较复杂的病变，估计支架经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球囊的经过性：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
7、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，预防支架内血栓构成，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不可盲目追求一切病例的大球囊高压力的后扩张，以免添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：常选择单标志、整体交换、小外径1.5-1.25-1.0mm球囊，如MaverickSprinterLegend等n n长病变：原那么上选用较长的球囊，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
8、、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MaverickPTCABalloonCathetersn nProprietarylaserbondedtechnologycreatesanextraordinaryTrakTipDesignandprecise,smoothbondsthroughouttheshaft.n nPushcoildesignandimproveddistalflexibilityforenhancedtrackability.n nOur1.5and2.0mmSoftLEAPBalloonsofferenhancedcrossa
9、bility.ApexPTCADilatationCathetern nSlopeOuterShaftsmoothlytransitionsSlopeOuterShaftsmoothlytransitionsn nfromstifftoflexible,allinonepiece,forfromstifftoflexible,allinonepiece,forn nmoreefficientpushtransmissionmoreefficientpushtransmissionn nBi-SegmentInnerShaftoptimizestheBi-SegmentInnerShaftopt
10、imizesthen nbalancebetweenpushandtrackbalancebetweenpushandtrackn nShorter,thinnermarkerbandsincreaseShorter,thinnermarkerbandsincreasen ndistalflexibilitydistalflexibilityn nRedesignedtipwithimprovedflexibilityandRedesignedtipwithimprovedflexibilityandn nwiremovement;sameultra-low0.017wiremovement;
11、sameultra-low0.017profileprofilen nOptiLEAPBalloonwithreducedwaistOptiLEAPBalloonwithreducedwaistn nthicknessprovidesgreatsizingflexibilitythicknessprovidesgreatsizingflexibilitywithwithn nlowerprofileslowerprofilesn nNano-compositematerialsaddsstructureandNano-compositematerialsaddsstructureandn np
12、ushabilitytotheoutershaftpushabilitytotheoutershaftQuantumMaverickBalloonn nLowprofile,fulllength1.8For2.0FMonorailshaftn nLowprofile3.2Fproximalover-the-wireshaftn nBioslideCoatingonaPEBAXDistalShaftn nLaserbondingtechnologyn nQuantumLEAPBalloonMaterialn nTaperedTrakTipDesignwith.017lesionentryprof
13、ile*NCsprintern n外形外形细细小的小的FasTracFasTrac头头端技端技术术- -可在遇到可在遇到n n较难经过较难经过的病的病变时变时提供极佳的提供极佳的经过经过才干；才干； n n柔柔软软耐用的耐用的FulcrumPlusFulcrumPlus球囊球囊资资料和料和MiniWrapMiniWrapn n折叠技折叠技术术提供提供细细小的外径和出色的再回抱才干；小的外径和出色的再回抱才干； n n 选择选择性的性的Dura-TracDura-Trac涂涂层层使球囊在到达和使球囊在到达和经过经过n n病病变变的的过过程中程中坚坚持耐久的光滑，在球囊持耐久的光滑，在球囊扩张扩张
14、n n时坚时坚持持稳稳定；定； n n 渐细钢丝设计渐细钢丝设计的推送杆加的推送杆加强强了球囊的跟踪能了球囊的跟踪能n n力和力和经过远经过远端病端病变变才干；才干； n n 光滑光滑细细小的小的导丝导丝交交换换口使口使3.5mm3.5mm以下的任何以下的任何n n两个球囊可在两个球囊可在6F6F0.0700.070的指引的指引导导管里管里对对吻。吻。n nSunflexTipissuperblyengineeredtogiveaSunflexTipissuperblyengineeredtogivean nperfectbalancebetweenflexibilityandkinkresi
15、stance.perfectbalancebetweenflexibilityandkinkresistance.n nZerotransitionbetweenthetipandwireforsmoothestZerotransitionbetweenthetipandwireforsmoothestn nentryprofile.entryprofile.n nTaperedTip:ThetaperedsofttipcombinedwithTaperedTip:Thetaperedsofttipcombinedwithn nadvancedlaserweldingtechnologypro
16、videstheadvancedlaserweldingtechnologyprovidesthen nmostcompetitivetipprofilemostcompetitivetipprofilen nSlidematrixdualcoatingisspeciallyformulatedwithSlidematrixdualcoatingisspeciallyformulatedwithn ntwouniqueproprietaryblends.HydrophilicandInviotwouniqueproprietaryblends.HydrophilicandInvion ncoa
17、tingsareappliedtothedistalleadingtipsectioncoatingsareappliedtothedistalleadingtipsectionn nandtheballoon/shaftsection,respectivelytoprovideandtheballoon/shaftsection,respectivelytoproviden nanoptimalbalancebetweenlubriciouscrossingandanoptimalbalancebetweenlubriciouscrossingandn nminimizingwatermel
18、onseedingminimizingwatermelonseedingn nTightFoldprocessingresultsinaslenderTightFoldprocessingresultsinaslendern nprimaryprofileforenhancedcrossabilityprimaryprofileforenhancedcrossabilityn nthroughtightlesions.throughtightlesions.n nSapphireNCSapphireNCOrbusNeichn nTheIPTransitionZoneoftheAvitaTheI
19、PTransitionZoneoftheAvitan nPTCADilatationCatheterprovidesPTCADilatationCatheterprovidesn nintensifiedpushability.intensifiedpushability.n nThenewtaperedtipdesignwithsoftThenewtaperedtipdesignwithsoftn nmaterialexhibitsaflexibletipforsmoothmaterialexhibitsaflexibletipforsmoothn nlesionentryandminima
20、lvesseltrauma.lesionentryandminimalvesseltrauma.n nTheInviocoatingontheinnerlumenTheInviocoatingontheinnerlumenn neliminatesfrictionbetweenthecathetereliminatesfrictionbetweenthecathetern nandguidewire.Invioisalsoappliedtoandguidewire.Invioisalsoappliedton ntheouterdistalsegmentfromthetiptheouterdis
21、talsegmentfromthetipn ntotheexitmarkerzoneforlubricioustotheexitmarkerzoneforlubriciousn ncrossability.crossability.n nAvitaHPAvitaHPOrbusNeichRuginn nCrossTipTMCrossTipTM确保确保确保确保RyuginRyugin经过经过性可以到达的最高性能。性可以到达的最高性能。性可以到达的最高性能。性可以到达的最高性能。CrossTipTMCrossTipTM是由特殊混合的是由特殊混合的是由特殊混合的是由特殊混合的弹弹性塑料聚合物制造而成。
22、性塑料聚合物制造而成。性塑料聚合物制造而成。性塑料聚合物制造而成。0.0170.017英寸英寸英寸英寸(0.043(0.043毫米毫米毫米毫米) )的的的的入口外径确保了入口外径确保了入口外径确保了入口外径确保了RyuginRyugin在完全在完全在完全在完全闭闭塞的病塞的病塞的病塞的病变变的复的复的复的复杂杂管腔里的管腔里的管腔里的管腔里的经过经过性。性。性。性。CrossTipTMCrossTipTM中等中等中等中等长长度的柔度的柔度的柔度的柔韧韧前端能前端能前端能前端能较较易地易地易地易地经过经过移植支架移植支架移植支架移植支架处处的病的病的病的病变变并并并并绷紧绷紧其其其其钙钙化病化病
23、化病化病变变。 n n亲亲水涂水涂水涂水涂层层M-CoatingM-Coating，塑料聚合物的复合，塑料聚合物的复合，塑料聚合物的复合，塑料聚合物的复合层层和新一代金属合金的和新一代金属合金的和新一代金属合金的和新一代金属合金的HypotubeHypotube。运用。运用。运用。运用RyuginRyugin经过过经过过度弯曲和大弯曲血管度弯曲和大弯曲血管度弯曲和大弯曲血管度弯曲和大弯曲血管时时，它能，它能，它能，它能顺顺滑的滑的滑的滑的到达目的病到达目的病到达目的病到达目的病变变部位，并且部位，并且部位，并且部位，并且胜胜利的利的利的利的处处置其复置其复置其复置其复杂闭杂闭塞病塞病塞病塞病变
24、变。n n提供广泛有效的球囊直径提供广泛有效的球囊直径提供广泛有效的球囊直径提供广泛有效的球囊直径选择选择范范范范围围从超从超从超从超细细的的的的1.251.25毫米直径到毫米直径到毫米直径到毫米直径到4.04.0毫米毫米毫米毫米直径不等。直径不等。直径不等。直径不等。n n薄型聚薄型聚薄型聚薄型聚酰酰胺球囊确保了其杰出的胺球囊确保了其杰出的胺球囊确保了其杰出的胺球囊确保了其杰出的经过经过性性性性RyuginCrossTipRyuginCrossTip是从尖端到是从尖端到是从尖端到是从尖端到薄型聚合物球囊的一段平滑薄型聚合物球囊的一段平滑薄型聚合物球囊的一段平滑薄型聚合物球囊的一段平滑过过度部
25、分，平滑柔度部分，平滑柔度部分，平滑柔度部分，平滑柔韧韧的的的的结结合体可以合体可以合体可以合体可以经过经过各各各各种复种复种复种复杂杂病病病病变变部位。部位。部位。部位。n n泰泰泰泰尔尔茂新一代茂新一代茂新一代茂新一代FC(FlexibleCorrugate)FC(FlexibleCorrugate)轴轴管成管成管成管成为衔为衔接高接高接高接高弹弹性的前端性的前端性的前端性的前端轴轴管和具管和具管和具管和具备强备强硬金属的硬金属的硬金属的硬金属的HypotubeHypotube轴轴管之管之管之管之间间的的的的桥桥梁。梁。梁。梁。FC-shaftFC-shaft是指是指是指是指经经过过加工的
26、柔加工的柔加工的柔加工的柔软软的胶的胶的胶的胶质轴质轴，该该技技技技术实现术实现了了了了经过经过一个平衡一个平衡一个平衡一个平衡轴轴加加加加强强力量的力量的力量的力量的传传输输性和性和性和性和弹弹性。性。性。性。 Voyagern nSuperbCrossTaperedTipDesignSuperbCrossTaperedTipDesignn nNewtaperedtipwith.017Newtaperedtipwith.017tipentryprofiledesignedtocrosstightlesionstipentryprofiledesignedtocrosstightlesions
27、n nImprovedtip-to-wireconformability1forconfidenttrackandcrossImprovedtip-to-wireconformability1forconfidenttrackandcrossn nPolyurethanetipmaterialisflexibleyetdurablefortoughlesionsPolyurethanetipmaterialisflexibleyetdurablefortoughlesionsn nFlexibletungstenmarkertechnologyallowscathetertoconformto
28、tortuousFlexibletungstenmarkertechnologyallowscathetertoconformtotortuousanatomyanatomyn nMoreOptionsLowProfileShaftDesignMoreOptionsLowProfileShaftDesignn nVersatiletreatmentina6FguideVersatiletreatmentina6Fguiden nExcellenttrackandpushintortuousanatomywithnewhypotubedesignExcellenttrackandpushinto
29、rtuousanatomywithnewhypotubedesignn nReinforcedmid-shaftdesignprovidesflexibilityandadditionalsupportReinforcedmid-shaftdesignprovidesflexibilityandadditionalsupportn nFlexibilitywithVisibilityProprietaryTungstenMarkerFlexibilitywithVisibilityProprietaryTungstenMarkern nNewmarkermaterialcomprisedoft
30、ungstenpolymerNewmarkermaterialcomprisedoftungstenpolymern nFlexiblemarkerdesignallowsthecathetertoconformmoreeasilytotortuousFlexiblemarkerdesignallowsthecathetertoconformmoreeasilytotortuousanatomyanatomyn nIncreasedmarkerflexibilityhelpstoreduceresistancewhencrossingtightIncreasedmarkerflexibilit
31、yhelpstoreduceresistancewhencrossingtightlesionslesionsn nPreciseDilatationProvenBalloonPerformancePreciseDilatationProvenBalloonPerformancen nShorttapersallowforprecisedilatationShorttapersallowforprecisedilatationn nImprovedLOFOLDBalloonTechnologyprocessesallowsforexcellentrewrapImprovedLOFOLDBall
32、oonTechnologyprocessesallowsforexcellentrewrapandrecross1andrecross1n nXCELONSBalloonMaterialachievessuperbflexibilityXCELONSBalloonMaterialachievessuperbflexibilityPowersailn nPLATEAUBalloonMaterialPLATEAUBalloonMaterialn nProvidesnon-complianceathighpressurewithoutProvidesnon-complianceathighpress
33、urewithoutcompromisingperformancecompromisingperformancen nFlexibilityandconformabilityforexcellentdeliverabilityFlexibilityandconformabilityforexcellentdeliverabilityn nLOFOLDBalloonTechnologyLOFOLDBalloonTechnologyn nProvidesalowcrossingprofileforexceptionallesioncrossProvidesalowcrossingprofilefo
34、rexceptionallesioncrossn nLOFOLDballoontechnologyforimprovedballoonrewrapLOFOLDballoontechnologyforimprovedballoonrewrapn nSoftTipDesignSoftTipDesignn nTaperedtipdesigncreatesalowentryprofileandexcellenttip-Taperedtipdesigncreatesalowentryprofileandexcellenttip-to-wireconformabilityforeasylesionacce
35、ssto-wireconformabilityforeasylesionaccessn nSofttipprovidesflexibilityfornegotiatingtortuosityandSofttipprovidesflexibilityfornegotiatingtortuosityandcrossingstentstrutscrossingstentstrutsn nDualSwagedMarkersDualSwagedMarkersn nProvidelowerprofilesthanconventionalmarkersProvidelowerprofilesthanconv
36、entionalmarkers为复杂病变设计的为复杂病变设计的MINITREKn nMINITREK独特的小底盘设计提供提供1.20mm,1.50mm和和2.00mm的球囊的球囊n nSafeCutusesdualwiremechanismtocreateSafeCutusesdualwiremechanismtocreaten nfocusedforce.Ithasabuilt-in0.011integralfocusedforce.Ithasabuilt-in0.011integraln nwireexternaltotheballoontohelptrackwireexternaltot
37、heballoontohelptrackn ntortuousvesselswithgreatefficiency.tortuousvesselswithgreatefficiency.n nAstandard0.014guidewirethatdeliverstheAstandard0.014guidewirethatdeliversthen ncathetertothetargetlesionalsoparticipatescathetertothetargetlesionalsoparticipatesn ninthedilatationprocess.Theguidewireexiti
38、nthedilatationprocess.Theguidewireexitn nportislocatedattheproximalpartoftheballoon.portislocatedattheproximalpartoftheballoon.n nDuringballoondilatation,thestandardguidewireandintegralwireapplyDuringballoondilatation,thestandardguidewireandintegralwireapplycontrolledforcetofacilitateplaquefractures
39、atlowinflationpressures.Thecontrolledforcetofacilitateplaquefracturesatlowinflationpressures.Thesameapplicationalsohelpsminimizeballoonslippage.sameapplicationalsohelpsminimizeballoonslippage.n nSafeCutsdistalleadingtipprofileis0.032taperedto0.028whichissmallerSafeCutsdistalleadingtipprofileis0.032t
40、aperedto0.028whichissmallerthanthoseofotherfocusedforceballoons.thanthoseofotherfocusedforceballoons.n nBalloonswithembeddedbladesforscoringthevesselhavehighcrossingBalloonswithembeddedbladesforscoringthevesselhavehighcrossingprofilesduetothenatureoftheballoonmaterialsandblades.profilesduetothenatur
41、eoftheballoonmaterialsandblades.n nTheintegralwireandstandardguidewireapplyevenlydistributedforcetoTheintegralwireandstandardguidewireapplyevenlydistributedforcetofacilitatecontrolledplaqueatlowpressures,reducingtraumatothevesselfacilitatecontrolledplaqueatlowpressures,reducingtraumatothevesselwall.
42、wall.n nOtherballoonsusingthesamefocusedforcetechnologyusebladeswhichareOtherballoonsusingthesamefocusedforcetechnologyusebladeswhicharemuchmoretraumatictothevesselwall.muchmoretraumatictothevesselwall.OrbusNeichCuttingBalloonn nTheFlexibilityYouWantTheFlexibilityYouWantn nNylonballoonmaterialdesign
43、edtoprovideflexibility,superbNylonballoonmaterialdesignedtoprovideflexibility,superbn ncomplianceandimprovedpunctureresistancecomplianceandimprovedpunctureresistancen nOverallbetterdeliverabilitytotreatmorecomplexlesions.Overallbetterdeliverabilitytotreatmorecomplexlesions.n nTheDeliverabilityYouNee
44、dTheDeliverabilityYouNeedn n30%moreDeliverablethantheCuttingBalloonUltra230%moreDeliverablethantheCuttingBalloonUltra2Device*Device*n n50%improvementinre-crosscomparedtotheCuttingBalloon50%improvementinre-crosscomparedtotheCuttingBalloonUltra2Device*Ultra2Device*n nThePredictabilityYouRelyOnThePredi
45、ctabilityYouRelyOnn nPrecisedilatationPrecisedilatationn nScoringtheplaquebyseveringtheelasticandfibroticScoringtheplaquebyseveringtheelasticandfibroticcontinuityofthevesselwallcontinuityofthevesselwalln nDilatingthelesionatlowerpressureswithlessrecoilDilatingthelesionatlowerpressureswithlessrecoiln nLumengainthroughplaquecompressioninsteadofvesselwallLumengainthroughplaquecompressioninsteadofvesselwallexpansionexpansion谢谢谢谢
