波科介入FilterWire中文保护伞.ppt

Click to edit Master title stylemfdk,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Confidential-For Internal Use Only -Do Not Copy or Distribute.,USCV5164.112.0,Confidential-For Internal Use Only -Do Not Copy or Distribute.,USCV5164.112.0,*,of 128,Click to edit Master title stylemfdk,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,波科介入FilterWire中文保护伞,The Product,Features and Intended Benefits,3,of 128,FilterWire EZ,Embolic Protection System,The FilterWire EZ System is BSCs second generation embolic protection filter.It incorporates a number of design changes from the FilterWire EX System(First Generation System)intended to improve the effectiveness and ease of use.,Europe,September 2003 commercialization for SVG,native coronary,peripheral and carotid intervention,Dominant market share(PV and CV)despite many other embolic protection filter competitors,US,August 2004 commercialization for SVG intervention,Increased market share and market penetration,December 2006 510(k)approved for carotid indication,4,of 128,FilterWire EZ,System Components,FilterWire EZ 5.5mm System,Protection Wire,EZ Delivery Sheath,EZ Retrieval Sheath,Accessories(peel-away introducer,guide wire torquer,valve dilator tool),FilterWire EZ Bent Tip Retrieval Sheath,(available separately),6,of 128,FilterWire EZ System,PEBAX is a registered trademark of Atofina Corporation,Atraumatic,3 cm,platinum,spring coil tip with floppy flexibility,Radiopaque,to enhance visualization,Shapeable to enhance,steerability,6.0 mm PEBAX,Nosecone,Flexible transition from the spring tip to the delivery sheath for excellent overall deliverability,Provides a profile transition that is designed to reduce the risk of debris,embolization,during system delivery,7,of 128,FilterWire EZ System,Polyurethane filter membrane with 110 micron pores,Designed to captures debris and reduce the risk of embolic related events,Intended to permit continuous blood flow for patient safety and comfort,Intended to permit continuous blood flow that allows contrast injections for visualization during the intervention,8,of 128,5.5 mm,4.5 mm,3.5 mm,FilterWire EZ System,Conforming,nitinol,filter loop with platinum coil,Highly visible to guide filter placement and to ensure good vessel wall apposition,One device,that accommodates vessels with,landing zone diameters,ranging from 3.5mm to 5.5mm minimizes sizing guesswork and inventory needs,Designed to provide continuous wall apposition around the circumference of the vessel lumen to minimize the opportunity for debris to collect on the outside of the filter,Automatically adjusts to changes in the vessel aperture,9,of 128,FilterWire EZ System,Filter loop suspension arm,allows the filter loop to move independently from the wire for good vessel wall apposition in both straight and curved anatomy,Simplifies the landing zone requirements by allowing use in both straight and curved vessels,No need to take 2 angio views to assess filter apposition,10,of 128,FilterWire EZ System,Spinner tube underlying filter assembly,Allows the wire to rotate independently from the delivery sheath for excellent system,steerability,.032”OD Catheter stop,Provides a barrier designed to prevent therapeutic devices from collapsing the filter frame,Lightly visible to contribute to visualization for device positioning*,*Note:A 0.013”OD part 5mm proximal to the catheter stop may also be visible with some equipment.,This part keeps the spinner tube in place,but lets catheter tips pass over.,12,of 128,EZ Delivery Sheath,150 cm PEBAX,Resin sheath with 100cm,peel-away exchange length,The distal sheath changes color from blue to clear to serve as a warning that the non peel-away section at the end of the sheath is approaching,1.1mm(0.042”or 3.2F)Lesion crossing profile,Distal end has a PTFE inner liner,Internal stop loading feature alerts the operator that the filter is fully sheathed,13,of 128,EZ Retrieval Sheath,150cm PEBAX,Resin sheath with a 20cm long exchange length,Soft distal tip,Designed to facilitate the capability to cross deployed stents,1.4mm(0.056”or 4.3F)lesion crossing profile,Internal stop capture feature,Alerts the operator that the filter is fully captured,14,of 128,EZ Bent Tip Retrieval Sheath,(sold separately),150cm PEBAX,Resin sheath with a 20cm exchange length,Bend at distal tip,The bend is designed to aid in crossing stent struts that can complicate filter retrieval,1.3mm(0.052”or 4.0F)lesion crossing profile,Internal stop capture feature,Alerts the operator that the filter is fully captured,FilterWire EZ Embolic Protection System,Step-by-Step Instructions,Product Demonstration,Please refer to the FilterWire EZ Embolic Protection System,DFU for complete instructions for use.,FilterWire EZ Embolic Protection System DFU available at,EZ System,DFU Card,17,of 128,FilterWire EZ Embolic Protection System,Pre-Procedure,Review the patients angiogram and determine if the vessel meets the requirements for safe and effective use of the,FilterWire,EZ System:,The apex of the loop can be deployed a,minimum of 3.0cm,from the distal edge of the lesion.,The vessel diameter at the desired location of the deployed filter loop is,3.5mm to 5.5mm,.,(2.25mm to 3.5mm for EZ Small),3.5mm 5.5mm vessel diameter,18,of 128,FilterWire EZ Embolic Protection System,Pre-Procedure(continued),Prior to using the,FilterWire,EZ System,anticoagulate,the patient to achieve an ACT of,275 seconds for carotid applications and,300 seconds for SVG applications(,200 seconds if GP,IIb/IIIa,inhibitors are used).,In the absence of ACT measurement,administer an appropriate weight based bolus of heparin(approximately 125 units/kg).,19,of 128,FilterWire EZ Embolic Protection System,Pre-Procedure(continued),RCA graft-most,commonly used guide,is the multipurpose.,Marginal graft-Hockey,stick guide is first choice,followed by left Amplatz,LAD or Diagonal graft,-most commonly used,guides are the left Amplatz,and Hockey stick.,Taken from Marco et.al.“Stenting of Degenerated Saphenous,Vein Grafts”May 2001 Euro PCR,Based on vessel take-off,physician should consider which guide catheter shape will provide the best access and support.,20,of 128,FilterWire EZ Embolic Protection System,PREP:Delivery System,1.Open the pouch using sterile handling procedure and place the packaging coils and accessory kit into the sterile field.,2.Unclip and remove the yellow housing that protects the filter.,Note:,The protection wire is pre-loaded into the delivery sheath.,3.Detach the pre-loadedprotection wire from the retaining clip,advance the delivery sheath,then grasp theclear section of the sheathand removesheathed wire from the coil.,FilterWire EZ System Product Packaging,21,of 128,4.Sheath the protection wire and filter by retracting the device into the EZ Delivery Sheath while the filter is immersed in heparinized saline.,NOTE:,Hold the Delivery sheath about 1cm proximal to the dark section.,NOTE:,Keep the filter unsheathed,until immediately prior to use.,FilterWire EZ Embolic Protection System,PREP:Delivery System(continued),3.Attach the wire torquer onto the proximal end of the protection wire.,Guide Wire Torquer,22,of 128,FilterWire EZ Embolic Protection System,Delivery,2.Insert the FilterWire EZ System and peel-away introducer assembly into a guide catheter/sheath.Once the FilterWire EZ System is inserted into the guiding catheter or guiding sheath,remove the peel-away introducer.,NOTE,:Use of a guiding catheter or a guiding sheath with a 1.91mm(0.075”)or larger,rotating,hemostasis valve is recommended when performing a procedure with the FilterWire EZ System.,The use of a sheath/guide catheter with a,fixed,hemostasis valve may cause the filter membrane to tear at the hemostasis valve upon removal.,1.Place the peel-away guide wire introducer over the tip of the delivery system(the spring tip of the system can be shaped as needed).,Peel-away Introducer Sheath,23,of 128,FilterWire EZ Embolic Protection System,Delivery(continued),3.To,advance,the FilterWire EZ System through the guiding catheter or guiding sheath,use a one-handed technique advancing both the delivery sheath and protection wire together;this will prevent accidental deployment of the filter.,4.,To,steer,the FilterWire EZ System to the target landing zone,use a two-handed technique,torquing the protection wire with one hand and advancing the delivery sheath with the other hand.,NOTE:,For carotid interventions,having the patient turn their head to the left or right will change the orientation of the vessel and may facilitate device passage.,NOTE:,Consider using the buddy wire technique if the lesion is difficult to pass.Retract the buddy wire after the lesion has been crossed by the FilterWire EZ System(If other efforts are unsuccessful,pre-dilatation can be used.),24,of 128,FilterWire EZ Embolic Protection System,Delivery(continued),5.,Advance the FilterWire EZ System across the lesion until the apex of the filter loop can be deployed a minimum of 3.0cm distal to the lesion.,NOTE:,If an interventional device with a tip-to-shoulder length of greater than 10.0mm is to be used,a longer vessel length may be required to place the FilterWire EZ System in order to avoid contact between the filters catheter stop and the tip of the interventional device.,25,of 128,Once the protection wire is in place past the lesion,slide the,torquer,tip up to the,hemostatic,valve and tighten firmly.,Deploy the filter by holding the protection wire with the,torquer,then retracting and completely removing the delivery sheath.,Be sure to keep the,torquer,in place as you peel-away the delivery sheath in a straight motion until the 3cm over-the-wire section is reached(see photo below).,FilterWire EZ Embolic Protection System,Filter Deployment,incorrect,CORRECT,Photograph taken by,Boston Scientific Corporation,26,of 128,4.Once the delivery sheath is completely removed,i,nject contrast and verify the device is in the proper position and there is adequate flow.,NOTE:,If repositioning is required,the EZ Retrieval Sheath should be used.Retract the protection wire and filter loop into the sheath,reposition the filter and redeploy.,5.,Use the protection wire like a traditional guide wire to track catheters and stent delivery systems to the target treatment area.,FilterWire EZ Embolic Protection System,Filter Deployment(continued),27,of 128,1.Inject contrast frequently and always after any intervention or exchange,to visually verify that blood flow is not obstructed and that filter loop/vessel apposition to the vessel wall is maintained.,CAUTION:,If a filter becomes occluded during the procedure,remove it and deploy a second filter if further intervention is required.,2.Complete the procedure making sure the protection wire remains in the proper position distal to the lesion(monitor fluoroscopy).,Note:,Failure to stabilize the protection wire could lead to inadvertent movement of the filter,resulting in protection wire entanglement and/or delay in the procedure.,FilterWire EZ Embolic Protection System,During the Procedure,28,of 128,FilterWire EZ Embolic Protection System,Filter Capture and Retrieval,1.Remove the EZ Retrieval Sheath from its packaging coil and flush with heparinized saline.,2.Advance the retrieval sheath over the protection wire past any deployed stents up to the proximal end of the filter loop.,Note:,If the EZ Retrieval Sheath is not able to pass the deployed stent,be sure the stent is well apposed and consider post-dilitation.If the Retrieval Sheath is still unable to cross,try the EZ Bent Tip Retrieval Sheath(available separately).,EZ Bent Tip Retrieval Sheath Packaging,29,of 128,FilterWire EZ Embolic Protection System,Filter Capture and Retrieval(continued),3.Gently and slowly retract the protection wire and filter loop back into the retrieval sheath until resistance is felt.,4.Observe the retrieval procedure under fluoroscopic imaging.,Note:,The distal edge of the collapsed filter loop should,align with,(see figure B),or be,proximal to,(figure A),the retrieval sheath marker band.,Retrieval Sheath Marker Band,A,B,30,of 128,FilterWire EZ Embolic Protection System,Filter Capture and Retrieval(continued),NOTE:,If resistance is felt before the distal edge of the collapsed filter loop is aligned with the marker band,it is possible that there is a large amount of embolic debris in the filter.Carefully retract the protection wire and EZ Retrieval Sheath as a system.The distal part of the filter bag will be outside of the sheath during retrieval in this case;however,the filter loop must be pulled fully into the sheath.,Fully Retracted Filter,Large Debris Load in Filter,31,of 128,FilterWire EZ Embolic Protection System,Filter Capture and Retrieval(continued),5.If any resistance is met during retraction of the sheathed FilterWire EZ System,slightly advance the sheathed FilterWire EZ System and rotate the sheath before continuing to retract.,6.Slowly and carefully retract the entire system until the tip of the retrieval sheath is adjacent to the tip of the guiding catheter or guiding sheath.,7.If there is any resistance,retract the guiding catheter and FilterWire EZ System together.This is done in case there is a large amount of embolic material captured in the filter that may not fit inside the guiding catheter.,32,of 128,FilterWire EZ Embolic Protection System,Filter Capture and Retrieval(continued),8.Remove the FilterWire EZ System from the patient.,NOTE:,When using a,rotating hemostasis valve,ensure that the hemostasis valve is fully opened prior to FilterWire EZ System removal.,CAUTION:,If a guide sheath with a fixed hemostasis valve is used,the valve dilator tool is required for FilterWire EZ System removal.Removing the FilterWire EZ System through a fixed hemostasis valve without the use of a valve dilator may cause the filter membrane to tear.,9.If a fixed hemostasis valve is used,place the valve dilator(if provided in the accessory kit)on the shaft of the retrieval sheath and slide the tool into the valve.Then remove the FilterWire EZ System from the patient through the valve dilator tool and remove the dilator.,33,of 128,Stent Entanglement,Potential for a distal embolic protection filter to entangle with a stent is inherent to interventional procedures using these devices.,SAFE PRACTICE FOR DISTAL PROTECTION FILTERS:,Achieve good guide catheter or guide sheath support,Ensure sufficient landing zone,Keep the filter in place during deployment,Minimize wire movement during the procedure,Achieve full stent apposition,34,of 128,FilterWire EZ Embolic Protection System,Tips for Use,Key Success Factors for Using the FilterWire EZ System,Keep,ACT levels,275 seconds for carotid procedures and,300 seconds for SVG procedures,.,If there is difficulty crossing the lesion,try a,buddy wire,and/or,for carotid procedures,have the,patient turn their head,to the left or right.,For carotid procedures,place the filter as distal as possible