经桡动脉途径肾动脉介入治疗.pptVIP

经桡动脉途径肾动脉介入治疗  罗建方广东省人民医院 Renovascular Disease Sites and Characteristics Atherosclerotic Ostial in nature Usually extends into the aorta 90% of renal stenoses Often Bilateral in patients 50 years Fibromusclar dysplasia (FMD) Series of arterial webs More common in females … Atherosclerotic Fibromusclar dysplasia Prevalence Prog Cardiovasc Dis 2009;52:184-195 Clinical presentation Hypertension Renal dysfunction Cardiac disorder syndromes 血流动力学意义的肾动脉狭窄 肾动脉管腔狭窄≥70% 血管造影示50～70%的狭窄, 为临界狭窄, 以下检查具有补充价值 测量跨病变压力阶差 ≤5F(有侧孔），ΔsBP≥20mmHg /Δm≥10mmHg FFR 0.9 选择性肾静脉肾素分析 经皮多普勒超声 核素肾显影技术 冠脉抽吸导管测压 抽吸导管外径 4+F 带端孔的PCI快速转换导管 避免单纯导管测量不利因素 a b a b Traditional intervention of renal artery stenosis Transfemoral intervention (TFI) Guiding catheter: 6/7/8F (RDC, JR) Guiding wire: 0.014/0.018/0.035” Stent: 5,6,7/15-24mm Limitations of TFI Limitations of TFI Transradial intervention (TRI)  may be an alternative approach Why TRI - renal artery stenting ? Anatomy Avoid difficulties and complications of TFI Most common course of renal artery points downward Renal artery diameter : 4~7 mm allows for low profile devices A= 75°B= 85° Device 6F long guiding catheter / wire / balloon 6F GD compatible stent systems A long Guiding Catheter 6F 125cm guiding catheter compatible stent systems Stent Shaft (L) GW 6F Guiding Stent (L) (cm) (inch) (mm) (mm) Palmaze Blue 142 0.014 4,5,6 12,15,18,24 Hippocampus 145 0.014 4~7 10,15,20,24 Express SD 150 0.018 4~6 15,18 Balloon expendable stent TRI via right radial artery TRI via left radial artery Pigtail / JR/ Amplaz Indications Steeply down-going renal arteries Avoid manipulation within an infra-renal AAA Patients without femoral access Aortic or iliac occlusion By the way