颈动脉支架手术步课件.pptx

1、循序渐进 建立标准 7F or 8F 的套管针7F 用于 8mm 以下的 Carotid Wallstent Monorail 8F 用于10 mm 以下的 Carotid Wallstent Monorail1.1.建立动脉通道建立动脉通道选择性颈总动脉造影选择性颈总动脉造影.035”标准导丝标准导丝4F or 5F 造影导管造影导管Imager II Headhunter or Sidewinder 置 stiff.035”导丝于颈外动脉 通过Y接头，置指引导管于颈动脉分叉处下1-2 cm 移出.035”导丝回撤鞘和输送鞘（附有滤网的导丝）分别置于不同的保护盘内黑色尾端：附有滤网的导丝和输

2、送黑色尾端：附有滤网的导丝和输送鞘鞘白色尾端白色尾端:回撤鞘回撤鞘撤除输送鞘，远端滤网显露出来撤除输送鞘，远端滤网显露出来准 备 用肝素盐水在原位冲洗输送鞘 取出附有滤网的导丝及输送鞘 滤网头端浸泡于肝素盐水中，移动输送鞘向上覆盖滤网，排除空气 导丝头端通过剥离鞘，置滤网导丝于Y阀中准 备理想的位置选择 滤网环最顶点距离病变远端至少3 cm理想的位置选择3 cm minimum1.5 cm minimum 血管直径介于3.5 5.5mm之间5.5mm3.5mm理想的位置选择 滤网放置于至少有2cm长的直血管 镍钛环距血管转弯处距离应 1cm理想的位置选择Imager II Headhunter

3、 or SidewinderAs the Wallstent deploys,it shortens from both ends towards the middle（可见到镍钛环已进入到鞘远端的标记中）视角 2:confirm apposition with crescent shapeFLOW:定期检查血流Advance the stent so that the radiopaque markers are positioned either side of the lesion to be stented滤网环最顶点距离病变远端至少3 cm4-1 FilterWire EZ动脉远端保

4、护装置 准 备If it is necessary to place a second Carotid WallstentFilterWire EZ动脉远端保护装置Contrast medium can be injected through the guiding catheterallow a minimum overlap of 5mm视角 1:Appears apposed镍钛环距血管转弯处距离应 1cm滤网放置于至少有2cm长的直血管确定支架两端的标记在病变外端Carotid Wallstent Deployment Technique Review4-2 FilterWire EZ

5、动脉远端保护装置 理想的位置选择注意不要移动滤网肝素盐水5ml冲洗支架内腔，见盐水从导丝口流出 one hand and two hands tech buddy wire?/视角视角 1:Appears apposed视角视角 2:confirm apposition with crescent shape 视角视角 2:Not apposed 旋紧扭控器，固定导丝/滤网 滤网定位，从两个不同的角度（垂直）造影以确定镍钛环是否紧贴血管壁 通过剥离的方式，抽出输送鞘，释放滤网A:导丝的头端B:滤网远端标记C:输送鞘标记D:镍钛环E:滤网近端标记ABCDABCD 随时稳定导丝随时稳定导丝 交换器

6、械时 交换指引导管时定期检查血流定期检查血流 如果血流较缓，须重新定位和释放 如果血流停止，立即撤出，1.PLACEMENT:确定滤网完全贴壁2.POSITION:手术的全过程中,保持滤网的位置不变3.FLOW:定期检查血流5.球囊预扩张球囊预扩张As the Wallstent deploys,it shortens from both ends towards the middleIf it is necessary to place a second Carotid WallstentCAUTION:If the tip of the Carotid Wallstent nose con

7、e catches the distal ends,free it with gentle movements!POSITION:手术的全过程中,保持滤网的位置不变堵住导丝口，继续冲洗，可见盐水从导管头端（鞘管头端标记处）流出，4-4 FilterWire EZ动脉远端保护装置 定 位&释 放如果血流停止，立即撤出，4-4 FilterWire EZ动脉远端保护装置 定 位&释 放4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流4-4 FilterWire EZ动脉远端保护装置 定 位&释 放旋紧扭控器，固定导丝/滤网FLOW:定期检查血流If it is necessary

8、 to place a second Carotid Wallstent4-4 FilterWire EZ动脉远端保护装置 定 位&释 放Deploy the Carotid Wallstent slowly a few millimeters at a timePost deployment滤网放置于至少有2cm长的直血管4 FilterWire EZ动脉远端保护装置 定 位&释 放The Guide Catheter can now be withdrawn and the procedure completed in the normal wayCarotid WallstentDepl

9、oyment6.颈动脉支架术 阅读指南阅读指南 确保无菌确保无菌 确定支架密封在鞘管内确定支架密封在鞘管内 肝素盐水肝素盐水5ml冲洗支架内腔，见盐水从导冲洗支架内腔，见盐水从导丝口流出丝口流出 堵住导丝口，继续冲洗，可见堵住导丝口，继续冲洗，可见盐水从导管头端（鞘管头端标记处）盐水从导管头端（鞘管头端标记处）流出，流出，InsertionLoad the stent catheter onto the proximal end of the FilterWire EX guidewire and advance the Carotid Wallstent to the lesion 沿着保护

10、伞导丝送支架到病变处沿着保护伞导丝送支架到病变处Maintain the delivery instrument as straight as possible outside the body 保持体外输送系统尽量直保持体外输送系统尽量直Advance the stent so that the radiopaque markers are positioned either side of the lesion to be stented 确定支架两端的标记在病变外端确定支架两端的标记在病变外端If it is necessary to place a second Carotid Wal

11、lstent allow a minimum overlap of 5mm 如果有用第二个支架，重叠部分最少要有如果有用第二个支架，重叠部分最少要有5mm6.颈动脉支架术 Carotid Wallstent Deployment Technique ReviewAs the Wallstent deploys,it shortens from both ends towards the middle 支架释放后，长度从两端向中间缩短支架释放后，长度从两端向中间缩短 Place the proximal and distal X-ray markers in the inner shaft ov

12、erlapping both sides of the stenosis内杆上支架两端的标记要超过狭窄的范围内杆上支架两端的标记要超过狭窄的范围Deploy the Carotid Wallstent slowly a few millimeters at a time释放支架需要较慢的速度释放支架需要较慢的速度Up to about half way it is possible to recapture the stent and re-position it支架释放一半以上时，还可以重新回收，重新定位支架释放一半以上时，还可以重新回收，重新定位6.颈动脉支架术 Carotid Walls

13、tentDeploymentImmobilize the stainless steel tube 固定不锈钢管固定不锈钢管Slide the T-connector gently towards the black release marker until the Carotid Wallstent is.在支架释放小于在支架释放小于50%时，将时，将T连接向黑色释放标记移动，连接向黑色释放标记移动，Check position of the partially deployed Carotid Wallstent within the stenosis 检查狭窄病变内部分释放的支架检查狭窄

14、病变内部分释放的支架Contrast medium can be injected through the guiding catheter造影剂可以通过指引导管注入造影剂可以通过指引导管注入 CAUTION:Do not push the stainless steel tube!注意：千万不要推动不锈钢管注意：千万不要推动不锈钢管6.颈动脉支架术Carotid WallstentDeploymentImmobilize the stainless steel tube againWhen the Carotid Wallstent is in its final position,gent

15、ly slide the T-connector on the stainless steel tube towards the heart shaped hub until the stent is completely deployed.Carefully remove the stent catheter,under fluoroscopic guidance,leaving the guidewire in place 支架定位后，固定不锈钢管，支架定位后，固定不锈钢管，向前推动向前推动T管，完全释放支管，完全释放支架架CAUTION:If the tip of the Carotid

16、 Wallstent nose cone catches the distal ends,free it with gentle movements!如果支架的头端触及滤网的如果支架的头端触及滤网的远端，轻柔将其移开远端，轻柔将其移开6.颈动脉支架术6.颈动脉支架术7.球囊后扩张 Ensure good in-flow and out-flow characteristic 确保流速正常确保流速正常 Good stent to wall apposition 支架贴壁更好支架贴壁更好 Closely monitor the ECG trace in the event of bradycard

17、ia during the post dilatation step.注意：如果后扩时出现心动过缓，密切注意心电图轨迹注意：如果后扩时出现心动过缓，密切注意心电图轨迹 Perform a control angiogram to confirm result of stent placement 沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内（可见到镍钛环已进入到鞘远端的标记中）（可见到镍钛环已进入到鞘远端的标记中）将整个的回撤鞘连同滤网导丝作为一个整体同时撤出将整个的回撤鞘连同滤网导丝作为一个整体同时撤出Filterwire EZ“EASY”The

18、Guide Catheter can now be withdrawn and the procedure completed in the normal wayThank You for your Attention!注意：千万不要推动不锈钢管（可见到镍钛环已进入到鞘远端的标记中）5 cm minimum视角 1:Appears apposed4-2 FilterWire EZ动脉远端保护装置 理想的位置选择滤网环最顶点距离病变远端至少3 cm支架释放后，长度从两端向中间缩短3 cm minimum7F or 8F 的套管针Place the proximal and distal X-ra

19、y markers in the inner shaft overlapping both sides of the stenosisallow a minimum overlap of 5mmAs the Wallstent deploys,it shortens from both ends towards the middleCarotid Wallstent Monorail Placement确定支架两端的标记在病变外端4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流Imager II Headhunter or Sidewinder旋紧扭控器，固定导丝/滤网4-4

20、 FilterWire EZ动脉远端保护装置 定 位&释 放As the Wallstent deploys,it shortens from both ends towards the middleFLOW:定期检查血流 滤网环最顶点距离病变远端至少3 cm理想的位置选择3 cm minimum1.5 cm minimum视角视角 1:Appears apposed视角视角 2:confirm apposition with crescent shape 视角视角 2:Not apposed 旋紧扭控器，固定导丝/滤网 滤网定位，从两个不同的角度（垂直）造影以确定镍钛环是否紧贴血管壁 通过剥

21、离的方式，抽出输送鞘，释放滤网 Carotid Wallstent Deployment Technique ReviewAs the Wallstent deploys,it shortens from both ends towards the middle 支架释放后，长度从两端向中间缩短支架释放后，长度从两端向中间缩短 Place the proximal and distal X-ray markers in the inner shaft overlapping both sides of the stenosis内杆上支架两端的标记要超过狭窄的范围内杆上支架两端的标记要超过狭窄的

22、范围Deploy the Carotid Wallstent slowly a few millimeters at a time释放支架需要较慢的速度释放支架需要较慢的速度Up to about half way it is possible to recapture the stent and re-position it支架释放一半以上时，还可以重新回收，重新定位支架释放一半以上时，还可以重新回收，重新定位6.颈动脉支架术allow a minimum overlap of 5mmCarotid Wallstent Monorail PlacementAs the Wallstent d

23、eploys,it shortens from both ends towards the middle撤除输送鞘，远端滤网显露出来Maintain the delivery instrument as straight as possible outside the bodyPlace the proximal and distal X-ray markers in the inner shaft overlapping both sides of the stenosis确定支架两端的标记在病变外端Imager II Headhunter or SidewinderFLOW:定期检查血流E

24、nsure good in-flow and out-flow characteristic视角 2:confirm apposition with crescent shape4-6 FilterWire EZ动脉远端保护装置 回 撤确定支架两端的标记在病变外端When the Carotid Wallstent is in its final position,gently slide the T-connector on the stainless steel tube towards the heart shaped hub until the stent is completely

25、deployed.Filterwire EZFLOW:定期检查血流allow a minimum overlap of 5mm035”导丝于颈外动脉FilterWire EZ动脉远端保护装置5 cm minimum4-1 FilterWire EZ动脉远端保护装置 准 备buddy wire?/视角 2:confirm apposition with crescent shape滤网环最顶点距离病变远端至少3 cmPOSITION:手术的全过程中,保持滤网的位置不变one hand and two hands tech旋紧扭控器，固定导丝/滤网4-4 FilterWire EZ动脉远端保护装置

26、 定 位&释 放沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内FLOW:定期检查血流4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流确定支架两端的标记在病变外端As the Wallstent deploys,it shortens from both ends towards the middle支架释放后，长度从两端向中间缩短Control Angiogram？支架的准备：4-3 FilterWire EZ动脉远端保护装置 进 入&前 进Imager II Headhunter or SidewinderCarotid Wallstent Deployment Techni

27、que ReviewAs the Wallstent deploys,it shortens from both ends towards the middleWhen the Carotid Wallstent is in its final position,gently slide the T-connector on the stainless steel tube towards the heart shaped hub until the stent is completely deployed.3 cm minimumPOSITION:手术的全过程中,保持滤网的位置不变As th

28、e Wallstent deploys,it shortens from both ends towards the middle肝素盐水5ml冲洗支架内腔，见盐水从导丝口流出滤网环最顶点距离病变远端至少3 cmCarotid Wallstent Monorail Placement如果血流停止，立即撤出，4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流视角 2:confirm apposition with crescent shape滤网环最顶点距离病变远端至少3 cm4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流As the Wallstent de

29、ploys,it shortens from both ends towards the middleAs the Wallstent deploys,it shortens from both ends towards the middle沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内Load the stent catheter onto the proximal end of the FilterWire EX guidewire and advance the Carotid Wallstent to the lesionFLOW:定期检查血流视角 1:Appears apposed滤网

30、环最顶点距离病变远端至少3 cmFilterWire EZ动脉远端保护装置Immobilize the stainless steel tube again循序渐进 建立标准保持体外输送系统尽量直滤网定位，从两个不同的角度（垂直）造影以确定镍钛环是否紧贴血管壁镍钛环距血管转弯处距离应 1cm滤网环最顶点距离病变远端至少3 cmCarotid Wallstent Monorail Placement确定支架两端的标记在病变外端4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流FLOW:定期检查血流视角 2:confirm apposition with crescent shap

31、eCarotid WallstentDeployment4-2 FilterWire EZ动脉远端保护装置 理想的位置选择滤网环最顶点距离病变远端至少3 cm4-4 FilterWire EZ动脉远端保护装置 定 位&释 放As the Wallstent deploys,it shortens from both ends towards the middle确定支架两端的标记在病变外端Ensure good in-flow and out-flow characteristicContrast medium can be injected through the guiding catheter4 5 FilterWire EZ动脉远端保护装置 稳 定&血 流Contrast medium can be injected through the guiding catheterAs the Wallstent deploys,it shortens from both ends towards the middle撤除输送鞘，远端滤网显露出来 The Guide Catheter can now be withdrawn and the procedure completed in the normal way