脑血管造影流程课件.ppt

1、.目的目的.目的目的.头颈部听诊头颈部听诊颈动脉分叉部（颈动脉）：甲状软颈动脉分叉部（颈动脉）：甲状软骨骨oror第第4 4颈椎水平颈椎水平锁骨上窝（锁骨下动脉）锁骨上窝（锁骨下动脉）眼眶部（眼动脉）眼眶部（眼动脉）头后部下方（椎动脉）头后部下方（椎动脉）.缺血性脑血管病血管内治疗手册.备皮备皮更换手术衣更换手术衣建立静脉留置通道建立静脉留置通道术前将检查资料（术前将检查资料（CT、MRI等）带等）带到导管室到导管室.器材器材穿刺器械：穿刺针、血管短鞘（穿刺器械：穿刺针、血管短鞘（4-6F）、短导）、短导丝、刀片、丝、刀片、注射器（注射器（5ml、10m1各各 1支）支）造影器械：造影器械：超

2、滑导丝超滑导丝 0.035/150cm、高压注射、高压注射器、造影管器、造影管(Pigtail、Headhunter、Simmons)、10m1注射器注射器1支支、2个三通接头、个三通接头、1个个Y型阀型阀、输液导管及造影连接管各、输液导管及造影连接管各1付。付。所有器械必须用肝素生理盐水冲洗，导管及鞘所有器械必须用肝素生理盐水冲洗，导管及鞘在进入血管前必须充分冲洗排气。在进入血管前必须充分冲洗排气。.药品：药品：.消毒消毒 .消毒消毒 .主动脉弓 无名动脉 左侧锁骨下动脉 右锁骨下动脉右颈总动脉左颈总动脉右颈内动脉左颈内动脉右椎动脉左椎动脉.沿导丝将导管送入颈总动脉近端沿导丝将导管送入颈总动

3、脉近端回撤导丝，回抽后用肝素生理盐水冲洗导管回撤导丝，回抽后用肝素生理盐水冲洗导管调整视野调整视野 颅外：正位：脊柱位于屏幕正中颅外：正位：脊柱位于屏幕正中 侧位：第三颈椎椎体位于屏幕正中侧位：第三颈椎椎体位于屏幕正中 颅内：正位头位：头颅居中，上界平颅盖骨颅内：正位头位：头颅居中，上界平颅盖骨 侧位：上界平颅盖骨，左界平额骨前部侧位：上界平颅盖骨，左界平额骨前部造影剂：流速造影剂：流速5ml/s,总量总量8ml (超选超选4ml/s,总量总量6ml).观察内容观察内容 是否存在狭窄、闭塞及严重扭曲是否存在狭窄、闭塞及严重扭曲 侧支循环代偿情况侧支循环代偿情况 有无发育异常有无发育异常 是否存

4、在动脉瘤、是否存在动脉瘤、AVM、血管夹层等、血管夹层等 .注意事项注意事项勿随意将导管头送入颈外动脉及颈内动脉勿随意将导管头送入颈外动脉及颈内动脉勿将导丝头送入颈内动脉勿将导丝头送入颈内动脉可行多角度投射造影可行多角度投射造影.将导管沿导丝置于锁骨下动脉内椎动脉将导管沿导丝置于锁骨下动脉内椎动脉 开口处造影开口处造影回撤导丝，回抽后用肝素生理盐水冲洗回撤导丝，回抽后用肝素生理盐水冲洗 导管导管.勿随意将导管头送入椎动脉内勿随意将导管头送入椎动脉内若右锁骨下近端狭窄，可将导管置入头若右锁骨下近端狭窄，可将导管置入头 臂干行右前斜头位造影臂干行右前斜头位造影若考虑为偏心性狭窄，可行多角度投射若考

5、虑为偏心性狭窄，可行多角度投射 造影造影.Black9F.1-PSI(max)2-French size3-Shaft length(usable)4-GW accept.CAS(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2025.HR=1.11 95%CI 0.81-1.51 P=0.51.HR=1.18 95%CI 0.82-1.68 P=0.38.卒中 HR=1.79 95%CI 1.14-2.82 P=0.

6、01 心梗 HR=1.35 95%CI 0.54-3.36 P=0.52.HR=0.07 95%CI 0.02-0.18 P0.0001.HR=0.94 95%CI 0.50-1.76 P=0.85.结论.External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHeadhunter5F Tempo200cmINTRODUCE GU

7、IDEWIRE AND INTRODUCER SHEATH.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryTerumo guidewire0.035”100cmHeadhunter5F Tempo200cmINTRODUCE GUIDEWIRE AND INTRODUCER SHEATH.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySELECTIVE CATHETHETERISATION OF ECATerumo gu

8、idewire0.035”100cmHeadhunter5F Tempo200cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIRETerumo guidewire0.035”100cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIRE.External Caroti

9、d ArteryInternal Carotid ArteryCommon Carotid ArteryHeadhunter5F Tempo200cmEXCHANGEGUIDEWIREAmplatz Emerald0.035”260cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryAmplatz Emerald0.035”260cmEXCHANGEINTRODUCER SHEATH.External Carotid ArteryInternal Carotid ArteryCommon Carotid A

10、rteryAmplatz Emerald0.035”260cmBrite Tip Sheath7F80cmEXCHANGEINTRODUCER SHEATH.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmREMOVE GUIDEWIRE.Carotid Artery Disease:Carotid Angioplasty-ProcedureHints.External Carotid ArteryInternal Carotid ArteryCommon Caro

11、tid ArteryBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryAngioguard0.014”300cmBrite Tip Sheath7F80cmINTRODUCE PROTECTION DEVICE.Angioguard Device:Delivery Sheath Covering Filter.External Carotid ArteryInternal Carotid ArteryCommon

12、 Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WITH PROTECTION DEVICEAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cmCROSS LESION WITH PROTECTION DEVICEAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid

13、 ArteryDEPLOYMENT PROTECTION DEVICEBrite Tip Sheath7F80cmAngioguard0.014”300cm.Angioguard Device:Filter Deployed.Carotid Artery Disease:Carotid Angioplasty-ProcedureHints.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArterySTENT DEPLOYMENT Smart Carotid stent7-8mm30-40mmBrite Tip Shea

14、th7F80cmAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmSTENT DEPLOYMENTAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-

15、8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid Artery Savvy balloon5-6mm3

16、0-40mmBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmPOSTDILATATIONAngioguard0.014”300cm Savvy balloon5-6mm30-40mm.External Carotid Arte

17、ryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROLAngioguard0.014”300

18、cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryRETRIEVAL PROTECTION DEVICEBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmAngioguard0.014”300cm.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIE

19、VAL PROTECTION DEVICEAngioguard0.014”300cm.Angioguard Device:Capture Sheath Retrieving Filter.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmRETRIEVAL PROTECTION DEVICEAngioguard0.014”300cm.Angioguard Device:Retrieved Basket.E

20、xternal Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL.External Carotid ArteryInternal Carotid ArteryCommon Carotid ArteryBrite Tip Sheath7F80cm Smart Carotid stent7-8mm30-40mmANGIOGRAPHICCONTROL.External Carotid Ar

21、teryInternal Carotid ArteryCommon Carotid Artery Smart Carotid stent7-8mm30-40mm.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(Boston Scientific)PRECISE(Cordis)Protg(ev3)(Abbott）.雕刻支架雕刻支架 编织支架编织支架.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.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.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.