慢性完全性闭塞地导丝技术介绍.ppt

Introduction wire techniques of chronic total occlusions Jun Dai , M.D. Coronary disease center Fuwai Hospital CAMS PUMC Beijing Contents Definition Pathology Angiography imaging PCI technical challenge guidewire technology interventional devices revascularization technology Definition of CTO Chronic total occlusions are defined as occlusions greater than 3(1) month old with angiographic TIMI 0 or TIMI 1 flow The Spectrum of Lumen Morphology in CTO: Clinical Challenges Chronic Total Occlusions What’s Blocking up the Lumen? 1. Dense Fibrotic Tissue: COLLAGEN! 2. Calcification Anatomic Descriptorsof Procedural Success CTO Guidewire Design CTO Guidewire Design Hallmarks of a CTO Guidewire ASAHI MIRACLEBROS? Family Straight Tip Guide Wires ASAHI CONFIANZA? 9 – Tapered Tip Guide Wires HI-TORQUE PILOTTM Family of Guide wire Cordis SHINOBI SHINOBI PlusCTO Guidewires Unique flattened tip designed to cross subtotal occlusions Guide Wire Selection Most important considerations Torque response Tip feel (tactile response) Tip shape – curve formation Hydrophobic vs.. Hydrophilic Wires Hydrophobic wires Provide better tactile response to operator Provide operator improved tactile response to better navigate micro-channels To get into the “dimple” and use tip load to purchase fibrous cap Hydrophilic wires Hydrophilic wires with tapered tip may improve the locating of micro-channels, however micro-channels can lead to false lumens/sub-intimal spaces Hydrophilic wires tend to follow the path of least resistance and generally offer less tip control Simplifyed sequence of wires Easy case ( big vessel, straight ) Crossit 100 Confianza pro Difficult case (calcifyed, tortuous, smaller) Miracle 3g Prox. Tortuosity: lubricious wires Miracle 4.5-12 g Confianza wires Why so difficult to cross it ? Sub-Intimal Path Wire technique for locating another channel –Tip Shape Is Key Wire tip for CTO CTO Guidewire Design Guidewire Operator Te