PCI之器械选择策略.ppt

Optimal Strategy of PCI Procedure PCI material Selecting the right tool for the procedure 1.Guiding catheters 2.Wires 3.Balloons 4.Stents 1.Guiding Catheters Function of Guide Catheter Conduit for transporting guide wire and device Mode for injecting contrast Platform for back up support during intervention Mechanism for measuring aortic and arterial pressures Basics A good or optimal strategy is 90% of the PCI procedure, There is a balance between support and aggressive intubation, Don’t forget difference in inner lumen, certainly in case of bifurcations, Don’t forget the 7 ＆ 8F option. 5,6,7,8Fguiding catheters? How to select the size of the catheter LEFT GUIDING: antero-posterior views LEFT CORONARY OSTIUM LEFT CORONARY OSTIUM LEFT CORONARY OSTIUM RIGHT CORONARY OSTIUM RIGHT CORONARY OSTIUM RIGHT CORONARY OSTIUM RCA SUPERIOR TAKE-OFF RCA INFERIOR TAKE-OFF BYPASS GRAFTS TRA / Guiding catheters Bifurcation Stenting via TRA Unprotected Left Main Stenting CTO How to choose the right Guide Catheter 2.Guide Wires Guide Wire Construction: basics Guide Wire Construction: basics Guide Wire Construction: basics Guide Wire Construction: basics Wire Selection Core Wire: Stainless/Nitinol Distal Core: Spring tip/Polymer tip Categories of Guide wire Guide Wire Shaping 3.Balloon Catheters Why are we still talking about Balloons? Types of Balloon Catheters Other Balloon Catheters Types Balloon Performance Compliance Compliance and Clinical Practices Compliance and Clinical Practices Conclusion 4.Stents Ideal Stent BMS VS DES (clinical view) Be careful when implanting stents without pre-dilatation!!! How to post-dilate ? Non compliant balloons High pressure Adequate size Adequate length (avoid geographical miss) How to post-dilate Post-dilatation * PROS CONS Smaller French Langer French Size of the Aortic root influence the size of the Guiding catheter Normal root size usually requires a primary curve of 4.0 Narrow root size usually requires a primary cur