PCI指引导管的选择医学课件.ppt

指引导管的支撑 轻微的同轴性调整，没有支撑力 同轴性调整，从 Valsalva窦获得额外支撑 同轴性调整，从对侧主动脉获得强大支撑 JR4 Hockey Stick EBU 额外支撑指引导管:从同侧的Valsalva窦获取支撑 要点: 这些指引导管能用于简单和复杂的PCI 在进行复杂PCI时术者需要掌握使用这类导管的时机和方法 遇到冠脉在主动脉内异常开口时考虑使用额外支撑导管 指引导管的操纵需要特殊的技巧 这些指引导管从Valsalva窦获取额外支撑 多功能导管 强力支撑导管:从对侧主动脉壁获得最大程度支撑 要点: 强力支撑导管通过对侧主动脉壁获得最大程度的支撑 这些指引导管的支撑力最强 强力支撑导管相比超强支撑导管容易使用 强力支撑的指引导管对复杂PCI是必须的 指引导管的选择 同轴性调整 解剖复杂，复杂病变，扭曲， 需要额外支撑 是 否 强力支撑导管 任何同轴性导管 从对侧主动脉 获取支撑(Voda, Geometric, EBU, Arani) 从Valsalva窦获取支撑(Amplatz, Hockey stick, El Gamal) 支撑导管 谢谢 * Normal aorta: The aorta has a normal curvature and diameter of 3.5 cm to 4.0 cm. The normal aortic configuration is found in 60 to 70 percent of all patients. Narrow aorta: The aortic arch has a very tight curve and a smaller diameter (less than 3.5 cm). Narrow aortic arches can make advancing guiding catheters and interventional devices more difficult. Dilated aorta: The aortic arch is at a more relaxed angle. The diameter is greater than 4.0 cm. * The size of the aortic root affects the curve size of the catheter to be used. The average aortic root generally requires a 4.0 cm curve guiding catheter, either an FL/JL for the LCA or an FR/JR for the RCA. A larger aortic root would require a larger curved catheter, such as an FL/FR 4.5 or 5.0 to provide adequate back-up support from the opposite aortic wall. A narrowed aortic root would require a smaller FL or FR curve. The curve not only affects back-up support, but also directs tip orientation. A shorter distance between the primary and secondary curves has a tendency to allow the catheter to move farther down into the aortic root, orienting the tip more superiorly, while a larger curve will sit higher in the root and tend to orient the tip more inferiorly. During the diagnostic procedure, one should note how the diagnostic catheter sits in the aorta. The diagnostic catheter only has to sit on the lip of the ostium to inject dye vs. the need for a guiding catheter to p