颈动脉支架置入术新版培训课件.ppt

1、颈动脉支架置入术新版颈动脉支架置入术新版SAPPHIRE 研究研究2颈动脉支架置入术新版ANGIOGUARD血栓保护装置血栓保护装置Cordis PRECISE支架支架3颈动脉支架置入术新版CONSENSUS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 4颈动脉支架置入

2、术新版EventsStent (159 pst)CEA (151 pts)p 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.

3、991.9%2.0% 0.99MI (Q or NQ)1.9%6.6%0.052.5%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

4、Patients 30-Day EventsSAPPHIRE (high-risk patients) 30 days and 12 months results SAPPHIRE (high-risk patients) 30 days and 12 month results“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 tre

5、ated 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。5颈动脉支架置入术新版Overall 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% : difference 显著差异显著差异, p = 0.06Death rate 死亡率死亡率6.9% vs. 12.6%: 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S

6、troke rate中风发生率中风发生率 5.7% vs. 7.3%: 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%Major 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% vs. 3.3% 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 = 0.03MI (Q or non Q) rate 心梗发生率心梗发生率2.5% vs. 7.9

7、%: patients 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) 30天内颅神经损伤的发天内颅神经损伤的发生率生率 0.0% vs. 5.3%: was significant for CEA arm外科组显著高于支架组，外科组显著高于支架组，p 0.016颈动脉支架置入术新版7颈动脉支架置入术新版8颈动脉支架置入术新版9颈动脉支架置入术新版CAS(n-1262)CEA(n=1240)年龄6969女性36

8、34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202510颈动脉支架置入术新版 HR=1.11 95%CI 0.81-1.51 P=0.5111颈动脉支架置入术新版12颈动脉支架置入术新版 HR=1.18 95%CI 0.82-1.68 P=0.3813颈动脉支架置入术新版 卒中 HR=1.79 95% CI 1.14-2.82 P=0.01 心梗 HR=1.35 95% CI 0.54-3.36 P=0.5214颈动脉支架置入术新版 HR=0.07 95% CI 0.02

9、-0.18 P0.000115颈动脉支架置入术新版 HR=0.94 95% CI 0.50-1.76 P=0.8516颈动脉支架置入术新版结论17颈动脉支架置入术新版18颈动脉支架置入术新版19颈动脉支架置入术新版20颈动脉支架置入术新版21颈动脉支架置入术新版22颈动脉支架置入术新版23颈动脉支架置入术新版 24颈动脉支架置入术新版50100 U/kg)25颈动脉支架置入术新版26颈动脉支架置入术新版27颈动脉支架置入术新版28颈动脉支架置入术新版29颈动脉支架置入术新版球扩式支架球扩式支架Palmaz Stent (Cordis)自膨式支架自膨式支架Carotid Wallstent (B

10、oston Scientific)PRECISE (Cordis)Protg (ev3) (Abbott）30颈动脉支架置入术新版雕刻支架雕刻支架 编织支架编织支架31颈动脉支架置入术新版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，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颈动脉支架置入术新版不足不足短缩、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颈动脉支架置入术新版优点优点顺应性好，适应不同形状

11、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34颈动脉支架置入术新版35颈动脉支架置入术新版36颈动脉支架置入术新版37颈动脉支架置入术新版38颈动脉支架置入术新版39颈动脉支架置入术新版40颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery41颈动脉支架置入术新版External Carotid ArteryInter

12、nal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHeadhunter5F Tempo200cmINTRODUCE GUIDEWIRE AND INTRODUCER SHEATH42颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHeadhunter5F Tempo200cmINTRODUCE GUIDEWIRE AND INTRODUCER SHEATH

13、43颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySELECTIVE CATHETHETERISATION OF ECATerumo guidewire0.035”100cmHeadhunter5F Tempo200cm44颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIRETerumo guidewire0

14、.035”100cm45颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIRE46颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIREAmplatz Emerald0.035”260cm47颈动脉支架置入术新版External Carot

15、id ArteryInternal Carotid ArteryCommon Carotid ArteryAmplatz Emerald0.035”260cmEXCHANGEINTRODUCER SHEATH48颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryAmplatz Emerald0.035”260cmBrite Tip Sheath7F80cmEXCHANGEINTRODUCER SHEATH49颈动脉支架置入术新版External Carotid ArteryInternal

16、Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmREMOVE GUIDEWIRE50颈动脉支架置入术新版Carotid Artery Disease :Carotid Angioplasty - ProcedureHints51颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE52颈动脉支架置入术新版External Caroti

17、d ArteryInternal Carotid ArteryCommon Carotid ArteryAngioguard0.014”300cmBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE53颈动脉支架置入术新版Angioguard Device :Delivery Sheath Covering Filter54颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WI

18、TH PROTECTION DEVICEAngioguard0.014”300cm55颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WITH PROTECTION DEVICEAngioguard0.014”300cm56颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryDEPLOYMENT PROTECTION D

19、EVICEBrite Tip Sheath7F80cmAngioguard0.014”300cm57颈动脉支架置入术新版Angioguard Device :Filter Deployed58颈动脉支架置入术新版Carotid Artery Disease :Carotid Angioplasty - ProcedureHints59颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySTENT DEPLOYMENT Smart Carotid stent7-8mm30-40mmBrite T

20、ip Sheath7F80cmAngioguard0.014”300cm60颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmSTENT DEPLOYMENTAngioguard0.014”300cm61颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheat

21、h7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm63颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery Savvy balloon5-6mm30-40mmBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm64颈动脉支架置入术新版External Caroti

22、d ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm Savvy balloon5-6mm30-40mm65颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mm

23、ANGIOGRAPHICCONTROLAngioguard0.014”300cm66颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm67颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryRETRIEVA

24、L PROTECTION DEVICEBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmAngioguard0.014”300cm68颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIEVAL PROTECTION DEVICEAngioguard0.014”300cm69颈动脉支架置入术新版Angioguard De

25、vice :Capture Sheath Retrieving Filter70颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIEVAL PROTECTION DEVICEAngioguard0.014”300cm71颈动脉支架置入术新版Angioguard Device :Retrieved Basket72颈动脉支架置入术新版External Carotid Arter

26、yInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL73颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL74颈动脉支架置入术新版External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery Smart Carotid stent7-8mm30-40mm75颈动脉支架置入术新版