脑血管介入常用材料.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,APOLLO,颅内动脉支架系统Intracranial Stent System,产品简介,：APOLLO颅内动脉支架系统由上海微创研制，是目前国内首个应用于脑动脉血管的支架系统。颅内动脉支架系统由颅内动脉支架和输送器组成。支架采用316L不锈钢，经激光切割而成。,APOLLO,颅内动脉支架系统,产品特点,1）支架结构采用正弦波的开放设计，并由一对“n”型连接键 呈空间“u”形连接，每组空间“u”形连接呈90度轴向交错排列，使支架具有优秀的柔顺性。2）正弦波的加强环结构支架保持支架径向支撑力而降低金属覆盖率。3）特殊的“镜面”抛光技术，提供无可挑剔的支架表面质量。4）特殊的支架压握技术，突出输送过程的安全性，并使输送系统保持较小的截面积，完成高难度手术操作。,APOLLO,颅内动脉支架系统,产品规格,主要技术指标,1.支架厚度为0.0040inch2.支架金属覆盖率2.5时为 13.60%3.支架扩张后短缩率3%，径向回弹率4%4.支架名义扩张压力为6atm，爆破压12atm5.支架压握后直径0.0365in.0.0391in.,*,最小导引导管的内径为,5F*,导引导丝直径为,0.014inch,Runner2球囊扩张导管,柔软、新型的超软端设计提高了导管的跟踪性能和穿越病变的能力，降低损伤血管壁的风险。,应用国际先进水准的新型高分子材料FANTAX。,凹陷型的显影点安装方式，减小了球囊折叠后的外径尺寸和显影点对球囊的损伤。,产品规格及主要技术指标,产品规格及主要技术指标,SATURN,远 端 保 护 器,Distal Protective Device,骨架选用了激光切割镍钛（NITI）合金。,远端保护器的主要构成是一个带有伞状滤网的0.014“导丝，滤网膜由高分子材料制成，上有大量0.1毫米微孔。,伞状滤网预装在熟料外鞘管中，鞘管有侧孔与带滤网导丝配合呈快速交换结构。,产品分类标记及技术规格,北京乐普,lepumedical/,同心,PARTNER雷帕霉素药物洗脱支架系统,使用雷帕霉素药物制剂具有良好的生物相容和缓释特性，能够确保临床使用的安全性和有效性。,采用双螺旋结构的设计提供强有力的血管支撑力，使支架能保持良好的支撑和贴壁性能，尤其在分叉开口完全闭塞钙化等病变中表现优异的性能。,支架品种规格长度由1236mm 直径由2.54.0mm规格型号齐全能够适用不同病变的临床要求。,主要技术指标,支架材质 AISI 316L医用不锈钢,支架厚度为0.0045inch,支架表面积 15-18%,缩短率为 小于1%,回弹率为 小于2%,径向抗压 大于16psi,球囊导管有效长度 1350mm,支架预装后直径 0.95-1.1mm,支架扩张后直径 2.50-4.00mm,支架长度 12-36mm,球囊允许压力 16atm,球囊导管结构 导丝快速交换型,涂层厚度 6m,药物剂量 1.2g/mm2,佳腾guidant,guidant/,RX ACCULINK Carotid Stent System,Self-expanding nitinol,6F sheath/8F guide catheter,Diameters:straight5.0,6.0,7.0,8.0,9.0,10.0 mm,tappered 6-8mm,7-10mm,lengths:20,30,40 mm,014 low-profile system,Compatible with 100 cm guiding catheters and sheaths,Stent Configurations,Material:Self-expanding Nitinol,Stent lengths:20,30*,40*mm,Stent diameters:,Straight:5-10 mm,Tapered:6*8 mm,7*10 mm,Stent Designed for Accurate Placement,3 longitudinal spines reduce shortening,Only 1.0%foreshortening,1,Unique Handle Design,Design enables one hand deployment,Eliminates“push-pull”technique,Placed on table or leg,stabilizing system for accurate placement,Designed for Accuracy,1,M,easured using 7X40mm ACCULINK stent.Tests performed by and data filed at Guidant.,RX ACCUNET Embolic Protection System,6F sheath/8F guide catheter compatible,4.5,5.5,6.5,and 7.5 mm basket diameters,recommended for use in arteries ranging from 3.25 mm to 7.0 mm,0.014”guide wire based,190 cm and 300 cm lengths,Polyurethane filter over nitinol basket,Maintains perfusion,Artery range,Basket,Profile,3.25 mm 4.0 mm 4.5 mm 3.5F,4.0 mm 5.0 mm 5.5 mm 3.5F,5.0 mm 6.0 mm 6.5 mm 3.7F,6.0 mm 7.0 mm 7.5 mm 3.7F,Excellent Deliverability,Guide wire and delivery sheath enter vessel as one unit,Highly flexible to navigate tortuous anatomy,Low profile and smooth transition from tip to filter basket,.014”wire is torqued independent from filter basket,Delivery Sheath Tip,Accurate Deployment,Rapid exchange unsheathing for stability and simplicity,Peel away delivery sheath allows for controlled deployment,Peel away Convertible Sheath,Capture and Control for Optimal Protection,Highly flexible filter basket designed to conform to tortuosity,Designed to capture high volume while allowing adequate blood flow,Concentric design with guide wire centered in filter,Four platinum radiopaque markers surround filter for visualization of wall apposition,Effective and Flexible Filter,Secure Filter Retrieval,Choice of two rapid exchange recovery catheters designed specifically for the challenges of filter recovery,RX ACCUNET Recovery Catheter,Shapeable Recovery Catheter Tip,RX ACCUNET 2 Recovery Catheter,Low-profile,flexible tip to allow for deflection away from stent struts during advancement,Flexible catheter/shaft optimized for challenging guide catheter/sheath access,Catheter shaft markers at 95 and 105 cm for reduced flouro time,美国美敦力公司(Medtronic,Inc.)medtronic,GuardWire Temporary Occlusion and Aspiration System,GuardWire Ordering Information,Racer Over-the-Wire Biliary Stent System,波士顿科学公司,(Boston Scientific Corp),bostonscientific,亚太地区产品,Carotid Wallstent Monorail Stent,FilterWire EX,NexStent Carotid Stent,Wingspan Stent System with Gateway PTA Balloon Catheter,Wingspan Stent System with Gateway PTA Balloon Catheter,3.5F Over-the-Wire(OTW)Stent Delivery System,0.014 in Guidewire Compatible,6F Guide Catheter Compatible,Stent diameter:2.5,3.0,3.5,4.0,4.5mm,Stent length:9,15,20mm,Balloon length:15,20mm,Balloon diamaeter:,15mm-1.5,2.0,2.25,2.5,2.75mm,20mm-1.5,2.0,2.25,2.5,2.75,3.0,3.25,3.5,3.75,4.0mm,Wingspan Procedure Overview,Gentle Pre-Dilation(6 atm):,undersized to 80%of the target vessel diameter,Atraumatic Stent Deployment,Highly Conformable Stent Design,Outward Radial Force,NexStent Carotid Stent,nitinol stent system,Low-profile,0.014 Monorail Delivery System,Stent Length:30mm,diameters from4mm-9mm(Dynamic Tapering Technology),Self-sizing,flat-sheet nitinol roll design acts as a tapered or straight stent,accommodating vessel diameters from 4mm-9mm,FilterWire EZ Embolic Protection System,FilterWire EZ Embolic Protection System,FilterWire EZ Embolic Protection System,1.Radiopaque Spring Tip(3.0 cm)2.Polyurethane Filter(110 micron pore size)3.Radiopaque Nitinol Loop4.Spinner Tube5.Proximal Stop6.PTFE Coated Wire(.014),FilterWire EZ Embolic Protection System,6F Guide Catheter Compatible(minimum ID.066”),3.55.5 mm Vessel Diameter Protection,WALLSTENT Endoprosthesis,Wallstent Iliac Endoprosthesis with Unistep Plus Delivery System,Self-expanding,支架直径：6 7 8 9 10 mm,支架长度：1869mm,导管直径：6F,导管长度：100 160cm,TAXUS Express Paclitaxel(紫杉酚)-Eluting Coronary Stent System,Neuroform3 Microdelivery Stent System,强生cordiscordis,jnjgateway,Cordis系列支架,PALMAZ GENESIS Transhepatic Biliary Stent,PALMAZ Transhepatic Biliary Stent,PALMAZ BLUE Transhepatic Biliary Cobalt Chromium Stent,PRECISE RX Transhepatic Biliary Stent,PRECISE Transhepatic Biliary Stent,S.M.A.R.T.CONTROL Transhepatic Biliary Stent,S.M.A.R.T.Transhepatic Biliary Stent 12mm&14mm,5.5F and 6F crossing profile.135cm catheter working length.0.014”and 0.018”guidewire acceptance.5F proximal shaft.,DIAMETER:5,6,7,8,9,10mm,LENGTH:20,30,40mm,Cordis PRECISE Nitinol SelfExpanding Stent,Cordis ANGIOGUARD Capture Guidewire,Eight Nitinol struts.Available in medium and extra support.100 micron basket pore size.,Angioguard 规格-选用,伞直径血管径释放鞘回收鞘,4mm3.0-3.5 3.2F 5.1F,5mm3.5-4.5 3.3F 5.1F,6mm4.5-5.5 3.5F 5.1F,7mm5.5-6.5 3.7F 5.1F,8mm6.5-7.5 3.9F 5.1F,Angioguard,SV.018 Guidewire,Steerability and Support,high level of support and torque response,EMERALD Guidewires,Shaping the way you approach diagnostic procedures,Enhanced maneuverability,Reduced likelihood of flaking,Finger Straightenability,Braided Angiographic Catheter,Superior torque response for fast and easy catheter positioning,Excellent pushability and kink resistance,Soft flexible atraumatic tip for enhanced trackability,Tapered tips for sheathless entry,Ev3 ev3,SpideRXTM Embolic Protection Device,Use of preferred 0.014-0.018 Guidewire-to reach and cross the lesion,Single Dual-Ended Low-Profile Catheter-one end for delivery and the opposite end for recovery,Pre-Loaded Filter/Capture Wire-ready to flush and deploy with no stylet or introducer,Fully Rapid Exchange-for primary wire,delivery and recovery of Capture Wire,6 Fr.Guide Catheter Compatible-for all SpideRX Filter sizes,Low 3.2 Fr.Crossing Profile-minimal interaction with the lesion during placement,Multiple Filter Sizes(3.0,4.0,5.0,6.0,7.0 mm)-optimal matching of the Filter to the vessel size,Longitudinal/Rotational Wire Movement-Filter designed to remain stationary during the intervention,Patency Up to 60 Minutes-HEPROTEC heparin-coated Filter,use in the iliac or subclavian arteries,EX.P.R.T.(Exact Placement Release Technology)Release for Accurate Stent Placement,Enhanced Radiopacity：Tantalum markers,Diamater:6,7,8,9,10mm,Length:20,30,40,60,80mm,Introducer sheath:6F,7F,Guidwire acceptance:0.018”,0.035”,6Fr/.014”Rapid Exchange,Simple,intuitive stent delivery system,Customized delivery catheter with radiopaque mid-marker band on tapered design,Diamater:straight-6,7,8,9,10mm,tapered-8*6mm,10*7mm,Length:straight-20,30,40,60mm,tapered-30,40mm,意大利,invatec,invatec/tool/home.phpinvatec-china,/,MO.MA脑保护装置近端血流阻断,Mo.Ma protects the brain from embolization by two highly compliant atraumatic balloons,blocking antegrade blood flow from the CCA(Common Carotid Artery)and retrograde blood flow from the ECA(External Carotid Artery):protection is established before the critical phase of lesion crossing.,美国雅培abbott/abbottvascular,吞并了guidant的血管内产品业务,Xact Carotid Stent System,Nitinol construction,Rapid exchange delivery system,Straight and tapered configurations,Stent Length:Straight-20,30mm,Tapered-30,40mm,Stent Diameter:Straight-7,8,9,10mm,Tapered-8*6,9*7,10*8mm,Emboshield Cerebral Embolic Protection System,0.014”Bare Wire with 0.018tip,7F guide catheter/6F sheath compatible,3.7-3.9F Filter Delivery System,Rapid Exchange System,Diameter:3,4,5,6mm,Crossing Profile:3.7F,3.9F,德国phytis,phytis.br/sidebranching.htm,The Phytis Diamond Sidebranch Stent,two cells designs in the same stent,coated with a unique Diamond-Like Carbon(DLC)coating,13mm stent with the larger cell structure located in the middle of the stent,17mm stent available in two versions,proximal and distal larger cell structure.,Stent Material:316LStainless Steel with Diamond-Like Carbon(DLC)coating,Rapid exchange hypo-tube delivery catheter,Nomial Pressure:8 atm,Rated Burst pressure:16 atm,Guide wire lumen:0,014(max),lenghts:9,12,16,20 e 25 mm,法国爱沙卡特公司HEXACATH,hexacath/,TITAN2支架,Made of stainless steel coated with Titanium-Nitride-Oxide,TITAN2 BAS(Bio Active Stent)is the unique alternative to DES(Drug Eluting Stent),独特的氮氧化钛（TiNO）涂层，降低再狭窄和支架内血栓，不需要长期双重抗血小板。,Widest range of coronary stents available today covering all physicians needs from 7mm to 28mm in length and from 2.0 to 5.0 in diameter.,rapid exchange,Stent range,Lengths:7,10 and 13 mmDiameters:2.0 and 2.25 mm,Profile,One of the lowest profile available down to 0.92 mm or 0.036 opening new crossability perspectives to physicians.,Metallic surface area,Designed to decrease the metal to artery ratio,the TITAN2 X-Small stent offers an optimised coverage of 18%and 17%for vessels of 2.0 and 2.25 mm.,Stent range,Lengths:13,16 and 19 mmDiameters:4.5 and 5.0 mm,Profile,Lower stent profile and a 1.9F shaft delivery catheter combined into a high performance coronary stent system reducing friction and risk of gas embolism.,Metallic surface area,The TITAN2 X-Large stent design provides better scaffolding for stenting in large or SVG vessels.Ratios of 18%and 17%in 4.5 and 5.0 mm diameters mean better support throughout the stented area.,日本泰尔茂TERUMO,terumomedical/terumo/,常用术语英文缩写,PTA Percutaneous transluminal angioplasty,CAS Carotid angioplasty and stenting,CEA Carotid endarterectomy,atm atmosphere 大气压 101.3kPa,F french scale 1F0.33mm,脑血管造影的顺序,第一步，主动脉弓造影。猪尾导管头置于主动脉弓起始部，管球左前30-45度角。,第二步，右侧颈动脉造影。先行右侧颈总动脉造影，此时需看侧位，导管头置于颈4椎体下缘。颈总动脉看完后，把导管送入颈内动脉，正侧位都要把颅骨内板内侧的脑组织包全，正位还要把管球向头侧倾斜,即汤氏位（Townes projection）。,第三步，左侧颈动脉造影。顺序基本同第二步。,第四步，左侧椎动脉造影。正位也要把管球向头侧倾斜30度。侧位要把外耳道放在显示器的中心。,第五步，右侧椎动脉造影。,脑血管造影常用位置,1.主动脉弓：左前斜约3040。,2.颈动脉：正位和斜位，左侧颈动脉加左前斜，右 侧加右前斜，度数约4560。,3.颈内动脉颅内段：正汤氏位侧位。,4.大脑中东脉：正汤加对侧斜，如左侧大脑中动脉为正汤右侧斜约3040。,5.大脑前动脉：正汤加同侧斜，如左侧大脑前动脉为正汤左侧斜约3040。,6.椎动脉：正汤加同侧斜，如左侧大脑后动脉为正汤左侧斜约3040，必要时加返汤。,肝素化,用肝素化方法较安全,初始量按体重（Kg）2/3计算（mg），或70-100u/Kg,一小时后追加初始量的一半。,若病人术前接受低分子肝素治疗，肝素用量减半。,术后鱼精蛋白中和,鱼精蛋白:肝素11.5:1,普通肝素剂型：每支12500u/100mg,常用材料费用,OTW(over the wire),经导丝传送系统,：球囊导管或支架的全长均在导丝上，需要用256cm超长导丝，在助手协助下完成操作。,RX(rapid exchang),快速交换系统,：球囊导管或支架只有顶端的一部分在导丝上，不需要超长导丝，单人即可完成操作。,再狭窄,椎动脉开口狭窄支架成形术后最容易再狭窄，最好使用药物涂层支架。,边缘效应：支架的末端未完全覆盖狭窄段，而是卡在动脉硬化斑块内，容易再狭窄。,椎动脉开口的狭窄，支架释放时容易移位，狭窄越短难度越大。,主动脉弓分型,