脉支架植入术图文详解.ppt

Endovascular Treatment of Renal Artery Stenosis Clinical Indications(Procedures) Anatomy Kidney anatomy Endovascular Treatment of Renal Artery Stenoses Aim of the treatment 1) Renovascular Hypertension 2) Renal Insufficiency Renovascular Hypertension 5% of all hypertensive patients Due to atherosclerosis or FMD Diagnosed after Surgical follow-up or PTRA. PTRA does not cure Essential Hypertension Renal Insufficiency Nephrosclerosis after RAS or occlusion PTRA is indicated to reverse or prevent the decline of kidney functions 8cm long kidney is the lower limit after which kidney function might be compromised Indications for PTRA Failed medical therapy Reducing drug treatment Pressure gradient 10% More than 50% stenosis Assymmetrical loss of renal mass Post-ostial lesion Fibro-Muscular Dysplasia Fibro-Muscular Dysplasia Restenosis after stenting Recent studies have indicated rates are between 10-20% (much better than the 30% with just PTA). Treatment Options Medical Treatment PTA with Stenting Surgery Dialysis: Renal Function never get better Gold standard treatment today… Medical treatment ACE inhibitors and a new class of Angiotensin receptor blockers Endovascular Options: PTA or Stenting ? 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion Literature… Product Strategies 014” Cardiologist, Radiologists, Vasc Surgeons. Balloon: M3 Rx Stents: Corinthian IQ on M3 Wire, Stabilizer 7-8F Vista Brite Tip or IG 035’ Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: P3, Opta Pro Stents: Genesis premounted on OPTA -PRO Wire 035, Jindo, Storq 8F Vista brite Tip or IG A new approach: .018 ! A GOOD COMPROMISE ! Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: Slalom Stent: Genesis premounted on OPTA -PRO Wire 018, SV 6-7F Vista brite Tip or IG Advantages of .014 systems Less spasm with .014 wire Less wire length Smaller puncture site Stent prot