颈动脉支架置入术ppt课件.pptx

1、12ANGIOGUARDANGIOGUARD血栓保护装置血栓保护装置Cordis PRECISECordis PRECISE支架支架3CONSENSUS一致同意一致同意RANDOMIZED, PROSPECTIVE随机，前瞻随机，前瞻性性310 (12 month)Stenting支架组支架组=159 / CEA=151STENTREGISTRY支架注册支架注册407SURGICAL REFUSAL外科拒绝外科拒绝SURGICALREGISTRY外科注册外科注册7INTERVENTIONALREFUSAL介入拒绝介入拒绝4EventsStent (159 pst)CEA (151 pts)p

2、ValueStent (159 pts)CEA (151 pts)p ValueDeath0.6%2.0%0.366.9%12.6%0.12Stroke3.1%3.3% 0.995.7%7.3%0.66Major ipsilateral0.0%1.3%0.240.0%3.3%0.03Major Non-Ipsilateral0.6%0.7% 0.990.6%0.7% 0.99Minor Ipsilateral2.5%0.7%0.373.8%2.0%0.5Minor Non -Ipsilateral0.6%0.7 0.991.9%2.0% 0.99MI (Q or NQ)1.9%6.6%0.05

3、2.5%7.9%0.04Q-Wave MI0.0%1.3%0.240.0%1.3%0.24Non-Q Wave MI1.9%5.3%0.132.5%6.6%0.1Death / Stroke3.8%4.6%0.78Death / Stroke / MI4.4%9.9%0.0811.9%19.9%0.06MAE withoutnon-neuro Death 30 days5.7%12.6% 30 days5.0%7.3%0.48Randomized Patients 12-Month EventsRandomized Patients 30-Day Events SAPPHIRE (high-r

4、isk patients) 30 days and 12 month SAPPHIRE (high-risk patients) 30 days and 12 month resultsresults“Stented patients are now 12 months out from treatment, and their MAE rate continue to be as good as, and in many ways better than, those for the surgically treated group.”接受治疗接受治疗12个月后，支架组病人不良事件的发生率相

5、当于，甚至在很多方面，优于手术治疗组。个月后，支架组病人不良事件的发生率相当于，甚至在很多方面，优于手术治疗组。5Overall MAE rateOverall MAE rate总体主要不良事件发生率总体主要不良事件发生率11.9% vs. 19.9% : 11.9% vs. 19.9% : difference difference 显著差异显著差异, , p = 0.06p = 0.06Death rate Death rate 死亡率死亡率6.9% 6.9% vs. 12.6%:vs. 12.6%: double number of patients died in the CEA ar

6、m double number of patients died in the CEA arm 外科组死亡人数比支架组多一倍外科组死亡人数比支架组多一倍Stroke rateStroke rate中风发生率中风发生率 5.7% 5.7% vs. 7.3%:vs. 7.3%: 30% more patients experienced a stroke in the CEA arm 30% more patients experienced a stroke in the CEA arm 外科组至少发生一次中风的病人数比支架组多外科组至少发生一次中风的病人数比支架组多30%30%Major Ip

7、silateral Stroke rateMajor Ipsilateral Stroke rate主要同侧大中风发生率主要同侧大中风发生率 0.0% 0.0% vs. 3.3%vs. 3.3% was significant higher in CEA was significant higher in CEA 外科组显著高于支架组，外科组显著高于支架组，p = p = 0.030.03MI (Q or non Q) rate MI (Q or non Q) rate 心梗发生率心梗发生率2.5% 2.5% vs. 7.9%:vs. 7.9%: patients got 3 times mo

8、re MI in the CEA armpatients got 3 times more MI in the CEA arm 外科组发生心梗的病人数比支架组多三倍以上外科组发生心梗的病人数比支架组多三倍以上Outcome of cranial nerve injury (30 days) 30Outcome of cranial nerve injury (30 days) 30天内颅神经天内颅神经损伤的发生率损伤的发生率 0.0% 0.0% vs. 5.3%:vs. 5.3%: was significant for CEA armwas significant for CEA arm外科

9、组显著高于支架组，外科组显著高于支架组，p 0.01p 0.016789CAS(n-1262)CEA(n=1240)年龄6969女性3634无症状性4747高血压8686糖尿病3030血脂异常8285目前吸烟2626心血管病4043平均收缩压mmHg14214170%狭窄的例数8587症状性狭窄发病天数202510HR=1.1195%CI 0.81-1.51P=0.511112HR=1.1895%CI 0.82-1.68P=0.3813卒中HR=1.7995% CI 1.14-2.82P=0.01心梗HR=1.3595% CI 0.54-3.36P=0.5214HR=0.0795% CI 0.

10、02-0.18P0.000115HR=0.9495% CI 0.50-1.76P=0.851617181920212223 2450100 U/kg)2526272829球扩式支架球扩式支架Palmaz Stent Palmaz Stent (Cordis)自膨式支架自膨式支架Carotid Wallstent Carotid Wallstent (Boston Scientific)PRECISE PRECISE (Cordis)ProtgProtg (ev3) (Abbott）30雕刻支架雕刻支架 编织支架编织支架31优点优点支撑力更大支撑力更大, ,不易塌陷不易塌陷柔韧性更强，表面光滑，

11、易于球囊通过柔韧性更强，表面光滑，易于球囊通过网孔密集，限制斑块脱落网孔密集，限制斑块脱落可重新定位、再次释放可重新定位、再次释放32不足不足短缩、不易精确定位短缩、不易精确定位拉伸颈动脉、上端扭曲、成角拉伸颈动脉、上端扭曲、成角凹凸不平处贴壁欠佳凹凸不平处贴壁欠佳33优点优点顺应性好，适应不同形状而不造成血管顺应性好，适应不同形状而不造成血管强直强直贴壁性好，不易造成死腔贴壁性好，不易造成死腔基本无缩短，定位和选择长度较精确基本无缩短，定位和选择长度较精确不足不足后扩时有连接点断裂的风险后扩时有连接点断裂的风险34353637383940External Carotid ArteryInte

12、rnal Carotid ArteryCommon Carotid Artery41External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHeadhunter5F Tempo200cmINTRODUCE GUIDEWIRE AND INTRODUCER SHEATH42External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHead

13、hunter5F Tempo200cmINTRODUCE GUIDEWIRE AND INTRODUCER SHEATH43External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySELECTIVE CATHETHETERISATION OF ECATerumo guidewire0.035”100cmHeadhunter5F Tempo200cm44External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Temp

14、o200cmEXCHANGEGUIDEWIRETerumo guidewire0.035”100cm45External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIRE46External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIREAmplatz Emerald0.035”260cm47Exte

15、rnal Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryAmplatz Emerald0.035”260cmEXCHANGEINTRODUCER SHEATH48External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryAmplatz Emerald0.035”260cmBrite Tip Sheath7F80cmEXCHANGEINTRODUCER SHEATH49External Carotid ArteryInternal Carotid Ar

16、teryCommon Carotid ArteryBrite Tip Sheath7F80cmREMOVE GUIDEWIRE50Carotid Artery Disease :Carotid Angioplasty - ProcedureHints51External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE52External Carotid ArteryInternal Carotid ArteryCommon Ca

17、rotid ArteryAngioguard0.014”300cmBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE53Angioguard Device :Delivery Sheath Covering Filter54External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WITH PROTECTION DEVICEAngioguard0.014”300cm55External Carotid

18、ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WITH PROTECTION DEVICEAngioguard0.014”300cm56External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryDEPLOYMENT PROTECTION DEVICEBrite Tip Sheath7F80cmAngioguard0.014”300cm57Angioguard Device :Filter Depl

19、oyed58Carotid Artery Disease :Carotid Angioplasty - ProcedureHints59External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySTENT DEPLOYMENT Smart Carotid stent7-8mm30-40mmBrite Tip Sheath7F80cmAngioguard0.014”300cm60External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite

20、 Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmSTENT DEPLOYMENTAngioguard0.014”300cm61External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm62External Carotid ArteryInternal Carotid ArteryCom

21、mon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm63External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery Savvy balloon5-6mm30-40mmBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm64Ex

22、ternal Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm Savvy balloon5-6mm30-40mm65External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-4

23、0mmANGIOGRAPHICCONTROLAngioguard0.014”300cm66External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm67External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryRETRIEVAL PROTECTION DEVI

24、CEBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmAngioguard0.014”300cm68External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIEVAL PROTECTION DEVICEAngioguard0.014”300cm69Angioguard Device :Capture Sheath Retrieving Filte

25、r70External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIEVAL PROTECTION DEVICEAngioguard0.014”300cm71Angioguard Device :Retrieved Basket72External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL73External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL74External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery Smart Carotid stent7-8mm30-40mm75