课件：卫生部心血管疾病介入诊疗技术培训教材冠心病分册第二版冠状动脉造影的基本方法及病变分析.ppt

* * Hockey Stick The Hockey Stick curves are often used for ostial or proximal lesions of superiorly oriented RCAs and CABGs. It has backup support between an FR and an Amplatz curve, and a straight primary curve that is good for delivering devices. The various lengths correspond to varying aortic root widths. A HS II would work best for a normal size root, a HS I for a small root and a HS III for a dilated root. El Gamal El Gamal has a straight primary curve with a longer tip and is occasionally used in accessing bypass grafts or difficult anatomy. El Gamal Relaxed has a more relaxed secondary curve than the El Gamal. These curves are designed to reshape to provide extra back-up support and engage difficult anatomical variations. Multipurpose Multipurpose curves are well suited for RCAs and bypass grafts. They have a gentle curve and long distal tip that works well in delivering the devices. They offer the ability to reshape the curve. Amplatz The Amplatz curve is used for maximum backup support, with the secondary curve firmly seated in the aortic root. If the tip of the guide does not reach the coronary ostium or falls into the ventricle, the curve is too small. If the guide tip remains in the coronary ostium or extends too high above the coronary ostium, the curve is too large. The tip of an Amplatz should be engaged by advancing it below the origin, rotating it counterclockwise and retracting it into position. It should be disengaged by advancing it and rotating it out of the ostium slowly versus pulling it back, which could cause the tip to “dive”. JL (Judkins Left) The JL curve is the standard LCA guide with an open primary curve. If the aortic root is narrow, use a smaller curve. If the aortic root is dilated, use a larger JL curve. In a normal aorta, when the guide tip has an inferior orientation below the ostium, the curve is too large. When the guide tip has a superior orientation above the ostium, the guide is too small. FL (Femoral Left) The FL