1、Boston Scientific1循序渐进 建立标准 27F 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3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 Sidewinder4 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5回撤鞘和输送鞘(附有滤网的导丝)分别置
2、于不同的保护盘内黑色尾端:附有滤网的导丝和输送黑色尾端: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6准 备7 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8理想的位置选择9 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 minimum10 血管直径介于3.5 5.5mm之间5.5mm3.5mm理想的位置选择11 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
3、1cm理想的位置选择1213 one hand and two hands tech buddy wire?/1415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16A: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ABCDABCD1718 随时稳定导丝随时稳定导丝 交换器械时 交换指引导管时19定期检查血流定期检查血
4、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,201.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21225.球囊预扩张球囊预扩张236.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,24 InsertionLoad the stent cathet
5、er onto the proximal end of the FilterWire EX guidewire and advance the Carotid Wallstent to the lesion 沿着保护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 s
6、ide 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 Wallstent 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25 Carotid Wallstent Deployment Technique ReviewAs the Wallstent deploys,it shortens from both ends towards
7、 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 possib
8、le 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26 Carotid WallstentDeploymentImmobilize 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
9、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27Carotid Wa
10、llstentDeploymentImmobilize the stainless steel tube againWhen 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.Carefully remove the stent catheter,under fluoroscopic guidance,l
11、eaving 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 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286.颈动脉支架术297.球囊后扩张 Ensure good in-flow and out-flow characte
12、ristic 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 bradycardia 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30 Perform a control angiogram to confirm result of stent placement3132 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3334Filterwire EZ“EASY”35 The Guide Catheter can now be withdrawn and the procedure completed in the normal way36Thank You for your Attention!37此课件下载可自行编辑修改,供参考!感谢您的支持,我们努力做得更好!38