医学常见的CTO病变介入治疗的器械选择.pptVIP

导丝的选择及使用技巧 球囊的选择及应用 * The FL curve has an acute tip and points superiorly. The EBU 3.5 has a long primary tip, provides good backup against the opposite wall of the aorta and engages coaxially. If the aortic root is normal, undersizing will cause the tip to point superiorly. * The FR 4.0 has an acute and superior orientation of the tip. The AL 1.0 offers good backup by the catheter backing into the aortic cusp. * The JR curve has a relaxed, almost straight tip and should engage well. The MB1 engages well in the inferior takeoff with its smooth, relaxed curve. An JR curve would point inferiorly, as opposed to a FR curve, which would point more lateral or slightly superior. Multipurpose catheters such as the El Gamal and Hockey Stick are also helpful in some right coronary arteries when the proximal segment is oriented downward. If the lesion is tight or distal, the backup provided by the FR catheter may prove inadequate. In such cases a straighter catheter such as the Multipurpose can be inserted into the RCA 2 cm to 3 cm providing a stable platform for the balloon to cross a tight stenosis. Single-curve catheters generally offer superb backup power and stability because the direction of force is in the same spatial plane as the target artery. CROSS-IT XT 导丝：逐渐变细的头端 CROSS-IT XT 导丝：头端硬度比较 LAD开口处闭塞病变 EBU 3.5 CRISS IT 100通过闭塞段 前降支开口部闭塞时导丝的选择—缠绕硬导丝 亲水涂层超滑导丝难以突破近端纤维帽 缠绕硬导丝能够轻易突破闭塞近端纤维帽 Miracle系列导丝结构及硬度比较 Conquest系列导丝的结构及硬度 Conquest系列导丝与其他导丝的比较 闭塞端呈鼠尾状：首选亲水涂层导丝 → RCA闭塞导丝及OTW球囊的选择 M6导丝通过闭塞段，但由于血管弯曲，硬导丝不能到达血管远端，不能证明导丝是否在血管真腔 通过OTW球囊造影证实在血管真腔 利用OTW球囊将M6更换为Asahi soft LAD慢性闭塞病变，闭塞端呈海蜇头状 LAD慢性闭塞病变在1.5mm球囊支撑下PT2 MS进入夹层 应用的器械包括： EBU 3.75指引导管 PT2-LS PT2-MS PILOT 150 CROSS IT 100 1.5*20mm球囊 LAD闭塞双导丝法成功退出PT2 MS导丝，M6导丝再次进入夹层。保留M6在夹层内，Cross IT100进入血管真腔 M6导丝进入夹层 保留M6，Cross IT 100进入LAD 前降支慢性闭塞双导丝法第一根导丝进入夹层，保持第一根导丝作为标志，第二根导丝寻找到血管真腔 临床目前较为常用的球囊 Boston：Maverick II，Quntum Cordis：Aquar，U-Pass Guildent：Crossail Medtronic：sprinter Teramo： Ryujin CTO桥侧支血管形成：球囊难通过 JR 4.0指引导管, P