肾动脉支架植入术图文详解.ppt

Endovascular Treatment of Renal Artery StenosisClinical Indications(Procedures)AnatomyKidney anatomyEndovascular Treatment of Renal Artery StenosesAim of the treatment1)Renovascular Hypertension 2)Renal InsufficiencyRenovascular Hypertension5%of all hypertensive patientsDue to atherosclerosis or FMDDiagnosed after Surgical follow-up or PTRA.PTRA does not cure Essential Hypertension Renal InsufficiencyNephrosclerosis after RAS or occlusionPTRA is indicated to reverse or prevent the decline of kidney functions8cm long kidney is the lower limit after which kidney function might be compromisedIndications for PTRAFailed medical therapyReducing drug treatmentPressure gradient 10%More than 50%stenosisAssymmetrical loss of renal massEndovascular Treatment of Renal Artery Stenoses1)Treatment of artheriosclerotic ostial lesions(80%)dilatation+stenting2)Treatment of post ostial lesions dilatation(stenting if necessary)3)Treatment FMD dilatation(stenting if necessary)Post-ostial lesionFibro-Muscular DysplasiaFibro-Muscular DysplasiaRestenosis after stentingRecent studies have indicated rates are between 10-20%(much better than the 30%with just PTA).Treatment OptionsMedical TreatmentPTA with StentingSurgeryDialysis:Renal Function never get betterGold standard treatment todayMedical treatmentACE inhibitors and a new class of Angiotensin receptor blockers Endovascular Options:PTA or Stenting?1999:Peter Van de Ven,randomized trialPTA vs Stenting in ostial lesionPTAStentingNumber of patients4243Primary patency rate29%75%Primary success rate57%88%Restenosis post-procedure48%14%LiteratureProduct Strategies014”Cardiologist,Radiologists,Vasc Surgeons.Balloon:M3 RxStents:Corinthian IQ on M3Wire,Stabilizer 7-8F Vista Brite Tip or IG035 Radiologist who are used to traditional PTA balloons,More range in PTA balloonsBalloons:P3,Opta ProStents:Genesis premounted on OPTA-PROWire 035,Jindo,Storq8F Vista brite Tip or IGA new approach:.018!A GOOD COMPROMISE!Radiologist who are used to traditional PTA balloons,More range in PTA balloonsBalloons:SlalomStent:Genesis premounted on OPTA-PROWire 018,SV6-7F Vista brite Tip or IGAdvantages of.014 systemsLess spasm with.014 wireLess wire lengthSmaller puncture siteStent protected by GCGood supportEndovascular Treatment of Renal Artery Stenoses 1)Through the groin using 8F materialsCan be downsized to 7F using M3Emerald.035Emerald.035+Pigtail Tempo 4-5F 65cmEmerald.035+Renal Curve Tempo 4F 65cmEmerald.035+Renal Curve Tempo 4F 65cmEmerald.035+RDC Vista Brite Tip 8F 55cmEmerald.035+RDC VBT 8F 55cm+Opta ProEmerald.035+RDC VBT 8F 55cm+Opta ProEmerald.035+RDC VBT 8F 55cm+Opta ProEmerald.035+RDC VBT 8F 55cmEmerald.035+RDC VBT 8F 55cm+Corinthian IQ on Opta ProEmerald.035+RDC VBT 8F 55cm+Corinthian IQ on Opta ProEmerald.035+RDC VBT 8F 55cm+Corinthian IQ on Opta ProEmerald.035+RDC VBT 8F 55cm+Corinthian IQ on Opta ProEmerald.035+RDC VBT 8F 55cm+Corinthian IQEndovascular Treatment of Renal Artery Stenoses2)Through the groin using the new 6F materials.014 Stabilizer.014 Stabilizer+6F Brite Tip Sheath 55cm.014 Stabilizer+6F BTS 55cm+RDC Tempo 4F.014 Stabilizer+6F BTS 55cm+RDC Tempo 4F.014 Stabilizer+6F BTS 55cm+RDC Tempo 4F.014 Stabilizer+6F BTS 55cm+RDC Tempo 4F.014 Stabilizer+6F BTS 55cm+M3.014 Stabilizer+6F BTS 55cm+M3.014 Stabilizer+6F BTS 55cm+Corinthian IQ on M3.014 Stabilizer+6F BTS 55cm+Corinthian IQEndovascular Treatment of Renal Artery Stenoses3)Through a brachial accessTempo 4F MP+.014 StabilizerBrite Tip Sheath 6F 90cm+.014 StabilizerBrite Tip Sheath 6F 90cm+.014 StabilizerBrite Tip Sheath 6F 90cm+RDC Tempo 4F+.014 StabilizerBTS 6F 90cm+.014 StabilizerBTS 6F 90cm+.014 Stabilizer+M3BTS 6F 90cm+.014 Stabilizer+M3BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3Endovascular Treatment of Renal Artery StenosesProceduralPost procedureEndovascular Treatment of Renal Artery StenosesPre operativePost operative