波科外周Guidewires中文导丝培训课件.ppt

Click to edit Master title stylemfdk,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Boston Scientific Confidential-For Internal Use Only.Do Not Copy,Display or Distribute Externally,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,Boston Scientific Confidential-For Internal Use Only.Do Not Copy,Display or Distribute Externally,Click to edit Master title stylemfdk,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,PI Guide Wires,Overview,Purposes of a guide wire:,导丝的作用：,Gain access into vessels,到达目标血管,Deliver devices,输送手术器械,Cross lesions,穿越病变部位,Used in vascular and non-vascular procedures,可用于血管和非血管介入手术,Used in all diagnostic and therapeutic procedures,可用于所有的诊断和治疗介入手术,The Backbone of every procedure,每例介入手术均需使用,PI Guide Wires,General Features&Intended Benefits,Ideal Guide Wire Features,Intended Benefit,Steerability/torque control,操控性,/,扭转控制,Easily directed through the body.,从体外操控导丝,Columnar strength,纵向强度,Kink resistant.,抗扭曲,Radiopaque,显影性,Good visualization.,良好的可视性,Frictionless,润滑性,Advancement through tortuous vessels;,通过迂曲的血管；,smooth tracking of devices&catheters.,沿导丝推送器械,&,导管,Rail support,支撑力,Advancement and support of devices.,推送和支撑器械,Atraumatic tip,无创伤的头端,Reduced vessel damage.,减少对血管的损伤,PI Guide Wires,General Components,外周介入导丝,的一般结构,Core Wire:Usually Stainless Steel or Nitinol,导丝轴芯：通常为不锈钢和镍钛诺合金,Distal Tip:Working end of wire;comes in multiple shapes:straight,angled,shapeable,J,远端头端：导丝的工作端；有多种形状：直型，成角型，可塑性，,J,型,Lubricious Coating:PTFE,Silicone,or Hydrophilic,光滑涂层：,PTFE,，硅，或亲水性,Distal Tip,远端,Safety Ribbon,安全带,Core wire,轴芯,Coil wire,螺旋金属丝,Proximal End,近端,Floppy/Light Support(POBA):,Starter Guide Wire,松软型,/,轻度支撑（,POBA,）：,Starter,TM,导丝,Most flexible;least rail support,最佳的柔韧性；最小的支撑力,Less likely to cause vessel damage,最小的血管损伤,Moderate Support(Stent):Magic Torque Guide Wire,中度支撑（支架）：,Magic Torque,导丝,Rail support between Floppy&Extra Support,介于松软型,&,超硬导丝之间,Added support for stent delivery,为放置支架提供额外的支撑,Extra Support(Stent):Amplatz Guide Wire,额外支撑（支架）：,Amplatz,导丝,Long rail support region,but soft tip,杆身支撑力更强，柔软的头端,Designed for first generation stent delivery,设计用于放置第一代的支架,PI Guide Wires,Core Wire Flexibility&Support,轴芯,柔韧性,&,支撑力,Diameters most commonly used in interventions:,在介入手术中最常使用的导丝直径：,.014”-Coronary and small vessel balloons,-,冠状动脉和小血管球囊,.018”-Renal and small vessel balloons,-,肾动脉和小血管球囊,.035”-Balloons and catheters,“workhorse”,-,球囊和导管，“使用最普遍”,.038”-Large devices requiring extra support(rarely used),-,需要额外支撑的较大器械（很少使用）,Other less common diameters are.032”and.025”,其他较少使用的直径：,.032”,和,.025”,Trend towards smaller diameters(.014”),趋向于小直径导丝（,.014”,）,Common guide wire lengths:,通常的导丝长度：,75cm,150cm,180cm,260cm,300cm,PI Guide Wires,Sizing Diameters&Lengths,尺寸,直径,&,长度,PI Guide Wires,Distal Tip Configurations,远端头端的类型,Tip Configurations:,头端类型：,Straight,angled,J-Tip,直型，成角型，,J,型,Non-hydrophilic,hydrophilic,非亲水性，亲水性,Standard,floppy,stiff,标准型，松软型，硬型,Tip taper,渐细的锥形头端,PI Guide Wires,Types for Gaining Initial Access,Bentson Guide Wire,Straight,floppy,atraumatic tip,J-Tip Guide Wire,Atraumatic-use when worried about the potential for vessel perforation.,无创伤,用于避免血管壁穿孔,Starter Guide Wire,Standard workhorse,ZIPwire Guide Wire,Not indicated as a starter wire,but often used by physicians.,PI Guide Wires,BSC Products,The three classifications of wires sold by Boston Scientific are:,Standard Guide Wires,标准导丝,Starter Guide Wire(includes Bentson,Newton,&Rosen shapes),Hydrophilic Guide Wires,亲水性导丝,ZIPwire Guide Wire(.18”,.025”,.035”,.038),Specialty Guide Wires,特殊导丝,V-18 Control Wire Guide Wire(.018),Platinum PLUS Guide Wire(.014”,.018“,.025”),Thruway Guide Wire(.014&.018),Magic Torque Guide Wire(.035),Amplatz Super Stiff Guide Wire(.035“&.038”),Meier Guide Wire(.035),PI Guide Wires,BSC Product Positioning,Starter Guide Wire,All routine procedures.,ZIPwire Guide Wire,When a standard wire wont“go”;total occlusions.,当标准导丝无法通过时；完全阻塞的病变,Amplatz Super Stiff Guide Wire,When more support is needed such as filter placement and carotid catheter placement.,当需要更多的支撑时，如放置血栓保护装置和颈动脉导管。,Magic Torque Guide Wire,Negotiating difficult vessels,sizing vessels,sizing IVC filters.,Meier Wire,AAA indicated;stiffer than Amplatz with a softer,radiopaque tip.,Platinum PLUS Guide Wire,IVUS,small vessel(.014”&.018”).,V-18 Guide Wire,Small vessels(.018”),tortuous anatomy,contralateral.,小血管（,.018”,），迂曲的血管，对侧病变。,Thruway Guide Wire,Small vessels(.014”&.018”),renals,monorail.,小血管（,.014”&.018”,），肾动脉，快速交换,Starter Guide Wires,The information included in this section is considered proprietary to Lake Region Manufacturing,Inc.Any copying,sharing and/or distributing is prohibited.,Starter Guide Wire,Product Positioning,A family of ultra-smooth,PTFE guide wires.,Workhorse guide wire for routine procedures.,Starter Guide Wire,Indications,INTENDED USE:,Starter guide wires are designed for percutaneous vessel entry using the Seldinger technique to facilitate subsequent introduction(s)of an intravascular device.,Starter,Guide Wire,Product Specs,Tips,Diameters(in),Lengths(cm),Bentson,.035,.038,150,180,260,Newton,.018,.035,.038,150,J-Tip*,.035,.038,150,180,260,Rosen,.035,150,180,260,Standard,.025,.035,.038,80,150,260,*Most are finger straightenable,Bentson,Newton,and Rosen are industry standard wire types sold by other companies as well.,Available with or without heparin coating.,Straight and J-tips available with fixed or moveable core(not available in all sizes).,Starter Guide Wire,Features&Intended Benefits,Starter Wire Features,Intended Benefits,PTFE coating applied using pre-coat technology(dipped vs sprayed),Increased coating consistency and durability to facilitate entry and smooth catheter tracking.,Availability of heparin coating,Decreased risk of thrombus formation.,Finger straightenable J-tip,Use in a wide range of clinical situations.,Choice of fixed or moveable core,Use in a wide range of clinical situations.,Starter Guide Wire,Areas of Clinical Use,Gaining access for routine procedures,Starter Guide Wire,Key Competitors,The following competitors also sell Bentson,Newton and Rosen wires,as well as other PTFE-coated competiting workhorse wires:,Cook market leader in standard guide wires,Angiodynamics,Cordis,St.Jude,Bard,Merit,Starter,Guide Wire,Key Takeaways,Atraumatic,workhorse guide wire for routine procedures.,Pre-Coat Technology,Dipped coating for excellent coating durability&consistency,Finger straightenable J-tip,Availability of heparin coating,Moveable&fixed core options,Sprayed Coating,Starter Guide Wire Dipped Coating (a.k.a.“Pre-Coat Technology”),GuidewiresConstruction-non hydrophilic wires,Starter,Guidewire Fixed Core,Ideal first wire to use before or after Introducer Sheath Insertion,Atraumatic Floppy Tip provides safety,Well balanced body provides ample pushability and support for Catheter Exchange,Precoat technology allows for ease of Catheter Exchange,Large Size Matrix covers majority of clinical requirements,Starter,Guidewire Moveable Core,Ideal first wire to use before or after Introducer Sheath Insertion,Moveable Core allows adjustment of the Floppy Tip length meaning one wire can provide both safety and support,Well balanced body provides ample pushability and support for Catheter Exchange,Precoat technology allows for ease of Catheter Exchange,Large Size Matrix covers majority of clinical requirements,Starter,Guidewire Newton,Ideal wire to use for accessing delicate vessels and crossing fragile lesions such as,Renal,Dialysis Fistula,Subclavian,Fempop.,Watch out 0.018”wires may be more suitable,Also ideal for navigation of heavily diseased Iliacs and Aortas.,Very Atraumatic Floppy tip,body support does allow catheter exchange,Starter,Guidewire New Bentson,Ideal wire to use for accessing delicate vessels and crossing fragile lesions such as,Renal,Dialysis Fistula,Subclavian,Fempop.,Watch out 0.018”wires may be more suitable,Also ideal for navigation of heavily diseased Iliacs and Aortas.,Very Atraumatic Tip,less support than Newton means that catheter exchange may be limited,Starter,Guidewire Rosen Heavy Duty,Ideal wire to use for catheter access where additional support is required especially in Ostial lesions due to short taper preventing flip out,Renal,Dialysis Fistula,Subclavian,Fempop.,Watch out 0.018”wires may be more suitable,ZIPwire Hydrophilic Guide Wires ZIPwire,亲水性导丝,ZIPwire Guide Wire,ZIPwire,Guide Wire,产品定位,A family of hydrophilic guide wires designed for smooth passage through tortuous anatomy.,设计用于流畅的通过迂曲的解剖结构,ZIPwire,Guide Wire,适应症,INDICATIONS:,The ZIPwire Hydrophilic Guide Wire is intended to facilitate the placement of devices during diagnostic and interventional procedures.,ZIPwire,亲水性导丝用于在诊断性和治疗性介入手术中协助置入器械。,ZIPwire,Guide Wire,产品技术参数,ZIPwire is a trademark of Boston Scientific Corporation or its affiliates.Glidewire is a trademark of Terumo Corporation.,Shafts,杆身,Standard,Stiff,标准型，加硬型,Tips,头端,Straight,Angled,J,Long Taper,Short Taper,直型，成角型，,J,型，长锥型，短锥型,Diameters,直径,.018”,.025”,.035”,.038”,Lengths,长度,80cm,150cm,180cm,260cm,Note:See Guide Wires brochure or price book for all available combinations.,注意：请参见相关产品彩页或手册了解所有的产品型号,ZIPwire,Guide Wire,Enhanced Manufacturing Process,A polymer jacket is extruded over a kink-resistant nitinol core.,聚合物外壳覆盖在抗扭曲的镍钛诺合金轴芯表面,Hydrophilic coating is bonded to the polymer jacket.,亲水性涂层粘合在聚合物外壳上,Radiopaque Polyurethane Jacket,不透,X,线的聚亚安酯外壳,Nitinol Core,镍钛诺轴芯,Hydrophilic Polymer Coating,亲水性聚合物涂层,The manufacturing process enhancements treated the surface of the polyurethane jacket for consistent adhesion of the hydrophilic coating.,ZIPwire Properties,Kink-resistant,抗扭曲性,The nitinol metal alloy core provides the strength necessary to make the ZIPwire guidewire kink-resistant.,镍钛诺合金材质的导丝轴芯使,ZIPwire,导丝具有良好的抗扭曲性能。,Steerable,操控性,Single piece construction and atraumatic tip allow excellent steerability.,一体式结构和无创性头端使其具有优异的操控性。,The unique alloy core and polyurethane jacket of the ZIPwire guidewire provide a true 1:1 torque response.,独特的合金轴芯和聚亚安酯外壳实现了,1:1,扭控反应。,Frictionless,光滑度,The hydrophilic coating makes the ZIPwire guidewire virtually frictionless when wet.The ZIPwire guidewire slides easily into place and smoothly guides catheters.,亲水性涂层在水化后变得非常光滑，易于到达病变部位和推送导管。,ZIPwire Properties,Low Thrombogenicity,(tendency to produce blood clots),低血栓性,（产生凝血块的趋势）,The frictionless coating results in low potential for the formation of blood clots on the surface of the ZIPwire guidewire.,光滑的亲水涂层有效减少了在导丝表面形成血凝块的危险。,Radiopaque,显影性,The polyurethane is impregnated with tungsten,a radiopacifier for enhanced visibility.,聚亚安酯外壳中含有钨，在,X,线下具有良好的可视性。,Atraumatic,无创性,The various cores result in soft,flexible tip configurations.,不同的轴芯,各种类型的柔软而富有弹性的头端。,ZIPwire,Guide Wire,Features&Intended Benefits,ZIPwire Guide Wire Features,Intended Benefits,Hydrophilic coating,亲水性涂层,Facilitation of crossing of tight lesions.,易于通过高度狭窄的病变,Precise 1:1 torque response,精确的,1:1,扭控反应,Secure control when sub-selecting distal and angulated branch vessels.,安全进入远端血管和成角较大的分支血管,Highly radiopaque jacket,高显影性外壳,Excellent visibility for accurate positioning.,良好的可视性，便于准确定位,Super-elastic nitinol core,有良好弹性的镍钛诺轴芯,Excellent kink-resistance.,优异的抗扭曲性能,ZIPwire,Guide Wire,临床应用领域,Aortic bifurcation area,腹主动脉分叉,Carotids,颈动脉,HAM,血透通路,Crossing CTOs,通过完全阻塞的病变,Subintimal Angioplasty,内膜下血管成形术,ZIPwire,Guide Wire,Key Competitors,Glidewire,Guide Wire,(Terumo-previously sold by Boston Scientific),-Hydrophilic market leader,Roadrunner Guide Wire,(Cook),AQUA,Liner,Guide Wire,(Angiodynamics),HiWire Guide Wire,(Cook),HydroSteer Guide Wire,(St.Jude Medical),ZIPwire,Guide Wire,Key Takeaways,The ZIPwire Guide Wire is a hydrophilic guide wire designed for maneuvering through tortuous anatomy.,ZIPwire,亲水性导丝设计用于通过迂曲的解剖结构。,Precise 1:1 torque response,精确的,1:1,扭控反应,Highly radiopaque jacket,高显影性外壳,Comprehensive selection of shafts,lengths,and tips,有多种不同硬度、长度和头端类型的型号,Amplatz Super Stiff Guide Wire Amplatz Super Stiff,超硬导丝,Amplatz Super Stiff Guide Wire,产品定位,A stiff,secondary(non-starter)wire when strength and stability are required for catheter placement and exchange.,硬度更高，具有更高的强度和稳定性，用于放置和更换导管。,Amplatz Super Stiff Guide Wire,适应症,INDICATIONS:,The Amplatz Super Stiff Guide Wire facilitates catheter placement and exchange during diagnostic or interventional procedures.It is not intended for use in coronary arteries.,Amplatz Super Stiff,超硬导丝用于在诊断性和治疗性介入手术中放置和更换导管。不适用于冠脉手术。,Amplatz Super Stiff Guide Wire,产品技术参数,Tip Shape,头端形状,Tip Length,头端长度,(cm),Diameters(in),直径,Lengths(cm),长度,3mm J,3mmJ,型,3,.035,.038,145,180,260,Straight,直型,6,.018,.035,.038,75,145,180,260,Short Tip,短头端,1,3.5,.035,.038,150,180,260,Note:See Guide Wire brochure or price book for all available combinations.,注意：请参见相关产品彩页或手册了解所有的产品型号,Amplatz Super Stiff,Guide Wire,Features&Intended Benefits,Amplatz Super Stiff Features,Intended Benefits,Stiff core,硬的轴芯,Added strength for easier access and better stability during catheter placement and exchange.,强度更高，进入更方便，在放置和更换导管时具有更佳的稳定性。,Atraumatic tip,&gradual distal core taper,无创性头端,&,渐细的远端轴芯,Safety during advancement.,在推进导丝时具有良好的安全性,Teflon coating,特氟隆涂层,Smooth entry and catheter tracking.,进入血管和推送导管更加流畅,Amplatz Super Stiff,Guide Wire,临床应用领域,Aortic bifurcation area,主动脉分叉,Carotid/aortic arch area,颈动脉,/,主动脉弓,Amplatz Super Stiff,Guide Wire,Key Competitors,“Amplatz”is a standard wire name sold by other companies including Cook and Cordis.,Others competing wires include:,Wholey HI-TORQUE,(Covidien),HI-TORQUE Supra Core,(Abbott Vascular),Amplatz Super Stiff,Guide Wire,Key Takeaways,Very supportive wire,具有高支撑力,For secondary use(not for gaining initial access),第二根导丝（不作为进入导丝）,Strong enough to get through tight lesions,yet tip is soft enough for reduced trauma during advancement.,具有足够的强度通过狭窄病变，同时柔软的头端可避免在推进导丝时损伤血管。,Amplatz Super Stiff,Guidewire,Super stiff wire body with an atraumatic tip for catheter placement and exchange in uroradiology,biliary drainage,abscess drainage and vascular procedures.,具有良好硬度的杆身和无创性头端，可用于在泌尿系统、胆道引流、脓肿引流和血管介入手术中放置和更换导管。,PTFE Coating helps to reduce friction and allows for easy catheter passage,PTFE,涂层减少了摩擦力，便于推进导管。,在具有出色的硬度、强度、稳定性的同时柔软的无创伤头端有良好的安全性,Magic Torque Guide Wire,Magic Torque Guide Wire,Product Positioning,.035,3CM,50CM,GLIDEX,180/260CM,Excellent torque control and radiopaque Magic Markers for enhanced visualization to meet the challenges of difficult anatomy.,Magic Torque Guide Wire,Indications,INDICATIONS:,The Magic Torque Guide Wire facilitates placement of a catheter during diagnostic or interventional procedures.The wire can be torqued to facilitate navigation through tortuous arteries and/or avoid unwanted side branches.,Magic Torque Guide Wire,Product Specs,Tip Shape,Tip Length(cm),Diameters(in),Lengths(cm),Shapeable,5,.035,180,260,Magic Torque Guide Wire,Features&Intended Benefits,.035,3CM,50CM,GLIDEX,180/260CM,Magic Torque Features,Intended Benefits,Shapeable 3cm tip,Flexibility for facilitating accurate placement,even in difficult anatomy.,Single piece core with to