脑血管介入常用材料.ppt

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1、脑血管病介入治疗常用材料,上海微创Microporthttp:/,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

2、，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

3、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http:/,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

4、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

5、 药物剂量 1.2g/mm2,佳腾guidanthttp:/,RX ACCULINK Carotid Stent System,Self-expanding nitinol6F sheath/8F guide catheter Diameters:straight5.0,6.0,7.0,8.0,9.0,10.0 mm tappered 6-8mm,7-10mmlengths:20,30,40 mm 014 low-profile system Compatible with 100 cm guiding catheters and sheaths,Stent Configurations,Ma

6、terial:Self-expanding NitinolStent lengths:20,30*,40*mmStent diameters:Straight:5-10 mmTapered:6*8 mm,7*10 mm,Stent Designed for Accurate Placement3 longitudinal spines reduce shorteningOnly 1.0%foreshortening1Unique Handle DesignDesign enables one hand deploymentEliminates“push-pull”techniquePlaced

7、 on table or leg,stabilizing system for accurate placement,Designed for Accuracy,1 Measured 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 us

8、e 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 basketMaintains 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 Deli

9、verability,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 stabil

10、ity 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 w

11、ith 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 Recover

12、y 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 flou

13、ro time,美国美敦力公司(Medtronic,Inc.)http:/,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)http:/,亚太地区产品,Carotid Wallstent Monorail Stent FilterWire EX NexStent Carotid Stent Wingspan Stent System w

14、ith Gateway PTA Balloon Catheter,Wingspan Stent System with Gateway PTA Balloon Catheter,3.5F Over-the-Wire(OTW)Stent Delivery System0.014 in Guidewire Compatible6F Guide Catheter CompatibleStent diameter:2.5,3.0,3.5,4.0,4.5mmStent length:9,15,20mmBalloon length:15,20mmBalloon diamaeter:15mm-1.5,2.0

15、,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 DeploymentHighly Conformable Stent DesignOutward Radial Force,NexStent Carotid Stent,nitinol stent system Low-pro

16、file,0.014 Monorail Delivery SystemStent 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 S

17、ystem,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

18、 Diameter Protection,WALLSTENT Endoprosthesis,Wallstent Iliac Endoprosthesis with Unistep Plus Delivery SystemSelf-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cordishttp:/http:/,Cordi

19、s系列支架,PALMAZ GENESIS Transhepatic Biliary Stent PALMAZ Transhepatic Biliary Stent PALMAZ BLUE Transhepatic Biliary Cobalt Chromium StentPRECISE 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

20、,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 Self-Expanding Stent,Cordis ANGIOGUARD Capture Guidewire,Eight Nitinol struts.Available in medium and extra support.100

21、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 approa

22、ch diagnostic proceduresEnhanced maneuverabilityReduced likelihood of flakingFinger 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

23、 tips for sheathless entry,Ev3 http:/,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 n

24、o 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 matchi

25、ng 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 Ste

26、nt Placement Enhanced Radiopacity：Tantalum markers Diamater:6,7,8,9,10mmLength:20,30,40,60,80mmIntroducer sheath:6F,7FGuidwire acceptance:0.018”,0.035”,6Fr/.014”Rapid ExchangeSimple,intuitive stent delivery systemCustomized delivery catheter with radiopaque mid-marker band on tapered design Diamater

27、:straight-6,7,8,9,10mm tapered-8*6mm,10*7mmLength:straight-20,30,40,60mm tapered-30,40mm,意大利invatec http:/,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 flo

28、w from the ECA(External Carotid Artery):protection is established before the critical phase of lesion crossing.,美国雅培http:/,吞并了guidant的血管内产品业务,Xact Carotid Stent System,Nitinol constructionRapid exchange delivery system Straight and tapered configurationsStent Length:Straight-20,30mm Tapered-30,40mmS

29、tent Diameter:Straight-7,8,9,10mm Tapered-8*6,9*7,10*8mm,Emboshield Cerebral Embolic Protection System,0.014”Bare Wire with 0.018”tip 7F guide catheter/6F sheath compatible 3.7-3.9F Filter Delivery System Rapid Exchange SystemDiameter:3,4,5,6mmCrossing Profile:3.7F,3.9F,德国phytishttp:/.br/sidebranchi

30、ng.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 stent17mm stent available in two versions,proximal and distal larger cell structure.,Stent Materi

31、al:316LStainless Steel with Diamond-Like Carbon(DLC)coatingRapid exchange hypo-tube delivery catheterNomial Pressure:8 atmRated Burst pressure:16 atmGuide wire lumen:0,014(max)lenghts:9,12,16,20 e 25 mm,法国爱沙卡特公司HEXACATH,http:/,TITAN2支架,Made of stainless steel coated with Titanium-Nitride-Oxide TITAN

32、2 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 rangeLengths:7,10 and 13 mm

33、Diameters:2.0 and 2.25 mm ProfileOne of the lowest profile available down to 0.92 mm or 0.036 opening new crossability perspectives to physicians.Metallic surface areaDesigned 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

34、and 2.25 mm.,Stent rangeLengths:13,16 and 19 mmDiameters:4.5 and 5.0 mm ProfileLower 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 areaThe TITAN2 X-Large stent design provides better

35、 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TERUMOhttp:/,常用术语英文缩写,PTA Percutaneous transluminal angioplasty CAS Carotid angioplasty and stentingCEA Carotid endarterectomyatm atmosphere 大气压 101

36、.3kPaF 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

37、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,