脑血管介入常用材料课件.ppt

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

2、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产品规格主要技术指标主要技术指标 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.支架直径(mm)支架长度(mm)8132.50A2508A25133.00A3008A3013*最小导引导管的内径为5F*导引导丝直径为0.014inchRunner2球囊扩张导管

3、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定货号扩张后球囊直径（mm）球囊有效长度（mm）名义压力（atm）额定爆破压力RBP（atm）管轴尺寸（F）远端/中部/近端1515pn1.5156142.5/2.9/2.12015pn2.0156142.5/2.9/2.12515pn2.5156142.5/2.9/2.13015pn3.0156142.5/2.9/2.13515pn3.5

4、156142.5/2.9/2.14015pn4.0156142.5/2.9/2.11520pn1.5206142.5/2.9/2.12020pn2.0206142.5/2.9/2.12520pn2.5206142.5/2.9/2.13020pn3.0206142.5/2.9/2.13520pn3.5206142.5/2.9/2.14020pn4.0206142.5/2.9/2.1产品规格及主要技术指标产品规格及主要技术指标定货号扩张后球囊直径（mm）球囊有效长度（mm）名义压力（atm）额定爆破压力RBP（atm）管轴尺寸（F）远端/中部/近端1525pn1.5256142.5/2.9/2.1

5、2025pn2.0256142.5/2.9/2.12525pn2.5256142.5/2.9/2.13025pn3.0256142.5/2.9/2.13525pn3.5256142.5/2.9/2.14025pn4.0256142.5/2.9/2.11530pn1.5306142.5/2.9/2.12030pn2.0306142.5/2.9/2.12530pn2.5306142.5/2.9/2.13030pn3.0306142.5/2.9/2.13530pn3.5306142.5/2.9/2.14030pn4.0306142.5/2.9/2.1SATURN远远端端保保护护器器Distal Pr

6、otective 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。SATURN滤网外径滤网外径适用血管适用血管导丝长度导丝长度导丝外径导丝外径输送鞘输送鞘管外径管外径回收鞘回收鞘管外径管外径鞘管长度鞘管长度型号型号mm mm mm FrenchFrenchmm SATURN-002.52.51800/30000.0142.841400SATURN-01331800/30000.0142.841400SATURN-02

7、441800/30000.0142.841400SATURN-03551800/30000.014341400SATURN-04661800/30000.014341400SATURN-05771800/30000.0143.541400SATURN-06881800/30000.0143.541400产品分类标记及技术规格产品分类标记及技术规格 北京乐普http:/ 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

8、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guidanthttp:/ nitinol6F sheath/8F guide catheter Diameters:s

9、traight5.0,6.0,7.0,8.0,9.0,10.0 mm tappered 6-8mm,7-10mmlengths:20,30,40 mm 014 low-profile system Compatible with 100 cm guiding catheters and sheaths Stent ConfigurationsMaterial:Self-expandingNitinolStentlengths:20,30*,40*mmStentdiameters:Straight:5-10 mmTapered:6*8 mm,7*10 mmStent Designed for A

10、ccurate Placement 3 longitudinal spines reduce shortening Only 1.0%foreshortening1Unique Handle Design Design enables one hand deployment Eliminates“push-pull”technique Placed on table or leg,stabilizing system for accurate placementDesigned for Accuracy1Measuredusing7X40mmACCULINKstent.Testsperform

11、edbyanddatafiledatGuidant.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 lengthsPolyurethane filter over nitinol basketMaintain

12、s 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 3.7FExcellentDeliverabilityGuide wire and delivery sheath enter vessel as one unit Highly flexible to navigate tortuous anatomy Low profile and smooth transitio

13、n from tip to filter basket.014”wire is torqued independent from filter basket DeliverySheathTipAccurateDeploymentRapid exchange unsheathing for stability and simplicity Peel away delivery sheath allows for controlled deployment PeelawayConvertibleSheath Capture and Control for Optimal Protection Hi

14、ghly 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 EffectiveandFlexibleFilter Secur

15、e Filter Retrieval Choiceoftworapidexchangerecoverycathetersdesignedspecificallyforthechallengesoffilterrecovery RX ACCUNET Recovery Catheter ShapeableRecoveryCatheterTipRX ACCUNET 2 Recovery Catheter Low-profile,flexible tip to allow for deflection away from stent struts during advancement Flexible

16、 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.)http:/GuardWireTemporaryOcclusionandAspirationSystemGuardWire Ordering Information Racer Over-the-Wire Biliary Stent System 波士顿科学公司波士顿科学公司(Bos

17、ton Scientific Corp)http:/亚太地区产品亚太地区产品Carotid Wallstent Monorail Stent FilterWire EX NexStent Carotid Stent Wingspan Stent System with Gateway PTA Balloon Catheter WingspanStentSystemwithGatewayPTABalloonCatheter3.5F Over-the-Wire(OTW)Stent Delivery System0.014 in Guidewire Compatible6F Guide Cathet

18、er CompatibleStent diameter:2.5,3.0,3.5,4.0,4.5mmStent length:9,15,20mmBalloon length:15,20mmBalloon diamaeter:15mm-1.5,2.0,2.25,2.5,2.75mm 20mm-1.5,2.0,2.25,2.5,2.75,3.0 3.25,3.5,3.75,4.0mmWingspanProcedureOverviewGentle Pre-Dilation(6 atm):undersized to 80%of the target vessel diameter Atraumatic

19、Stent DeploymentHighly Conformable Stent DesignOutward Radial ForceNexStentCarotidStentnitinol stent system Low-profile,0.014 Monorail Delivery SystemStent Length:30mm diameters from 4mm-9mm(Dynamic Tapering Technology)Self-sizing,flat-sheet nitinol roll design acts as a tapered or straight stent,ac

20、commodating vessel diameters from 4mm-9mm FilterWireEZEmbolicProtectionSystem FilterWireEZEmbolicProtectionSystemFilterWireEZEmbolicProtectionSystem1.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)

21、FilterWireEZEmbolicProtectionSystem6F Guide Catheter Compatible(minimum ID.066”)3.55.5 mm Vessel Diameter ProtectionWALLSTENTEndoprosthesis WallstentIliacEndoprosthesiswithUnistepPlusDeliverySystemSelf-expanding 支架直径：支架直径：678910mm支架长度：支架长度：1869mm导管直径：导管直径：6F导管长度：导管长度：100160cmTAXUS Express Paclitaxel

22、(紫杉酚)-Eluting Coronary Stent SystemNeuroform3MicrodeliveryStentSystem 强生cordishttp:/http:/Cordis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 Ste

23、nt 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:20,30,40mmCordis PRECISE Nitinol Self-Expanding StentCordis

24、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 5.1FAngioguardSV.018 Guidewire SteerabilityandSupporthi

25、ghlevelofsupportandtorqueresponseEMERALDGuidewiresShapingthewayyouapproachdiagnosticproceduresEnhancedmaneuverabilityReducedlikelihoodofflakingFinger StraightenabilityBraidedAngiographicCatheter Superior torque response for fast and easy catheter positioning Excellent pushability and kink resistance

26、 Soft flexible atraumatic tip for enhanced trackability Tapered tips for sheathless entry Ev3 http:/SpideRXTMEmbolicProtectionDevice Useofpreferred0.014-0.018Guidewire-toreachandcrossthelesionSingleDual-EndedLow-ProfileCatheter-oneendfordeliveryandtheoppositeendforrecoveryPre-LoadedFilter/CaptureWir

27、e-readytoflushanddeploywithnostyletorintroducerFullyRapidExchange-forprimarywire,deliveryandrecoveryofCaptureWire6Fr.GuideCatheterCompatible-forallSpideRXFiltersizesLow3.2Fr.CrossingProfile-minimalinteractionwiththelesionduringplacementMultipleFilterSizes(3.0,4.0,5.0,6.0,7.0mm)-optimalmatchingoftheF

28、iltertothevesselsizeLongitudinal/RotationalWireMovement-FilterdesignedtoremainstationaryduringtheinterventionPatencyUpto60Minutes-HEPROTECheparin-coatedFilteruse in the iliac or subclavian arteries EX.P.R.T.(Exact Placement Release Technology)Release for Accurate Stent Placement Enhanced Radiopacity

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

30、mm,10*7mmLength:straight-20,30,40,60mmtapered-30,40mm意大利invatec http:/ 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 estab

31、lished before the critical phase of lesion crossing.美国雅培美国雅培http:/ Carotid Stent System Nitinol constructionRapid exchange delivery system Straight and tapered configurationsStent Length:Straight-20,30mm Tapered-30,40mmStent Diameter:Straight-7,8,9,10mm Tapered-8*6,9*7,10*8mm EmboshieldCerebralEmbol

32、icProtectionSystem 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/sidebranching.htmThePhytisDiamondSidebranchStent two cells designs in the same stent coated with

33、 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 Material:316LStainless Steel with Diamond-Like Carbon(DLC)coatingRapid exchange hypo-tube deliver

34、y 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HEXACATHhttp:/ 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

35、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 StentrangeLengths:7,10 and 13 mmDiameters:2.0 and 2.25 mm ProfileOne of the lowest profile available down to 0.92 mm or 0.036 opening new c

36、rossability perspectives to physicians.MetallicsurfaceareaDesigned 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.StentrangeLengths:13,16 and 19 mmDiameters:4.5 and 5.0 mm ProfileLower stent profile and a 1.9F s

37、haft delivery catheter combined into a high performance coronary stent system reducing friction and risk of gas embolism.MetallicsurfaceareaThe 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 sup

38、port throughout the stented area.日本泰尔茂TERUMOhttp:/ Percutaneous transluminal angioplasty CAS Carotid angioplasty and stentingCEA Carotid endarterectomyatm atmosphere 大气压 101.3kPaF 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

39、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

40、。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