睹彬椎动脉支架植入术终稿.ppt

椎动脉支架的植入技巧 操作过程中注意 可视范围 路径图 操作过程中平静呼吸 A less common type of VA disease involves multiple tandem lesions with tortuosity and angulation. The stiff Palmaz stent is ill-equipped for this. Finally, for lesions in the V2 segment, where the vessel passes through the VA canal, the ordinary vessel overstretch mechanism of PTA is inefficient because of the bone surrounding the vessel. Here, we first used flexible balloon-expandable stents (that is, Multilink, GFX), but quickly switched to the self-expandable type (Radius or Magic Wallstent) because of the theoretical risk of stent compression by the surrounding bone during neck movements. 椎动脉支架的植入技巧 引 言 与后循环卒中相关的死亡率在20~30%，远高于前循环梗死的死亡率 后循环的动脉粥样硬化性狭窄，常见部位是椎动脉开口 椎动脉开口的支架成形治疗是安全、可行的 Crawley F, Brown MM. Cochrane Database Syst Rev 2:CD000516,2000. Higashida RT, Tsai FY, Halbach VV, et al. J Neurosurg 78:192–198, 1993. Moufarrij NA, Little JR, Furlan AJ, et al. Stroke 15:260–263, 1984. Rocha-Singh K: Vertebral artery stenting. Catheter Cardiovasc Interv 54:6–7, 2001. Spetzler RF, Hadley MN, Martin NA, et al. J Neurosurg 66:648–661, 1987. 引 言 任何技术的使用，首先要服从于安全 技术的应用与下列因素有关 与操作者的经验 常用的器材 对器材的了解 大 纲 投照体位 入路的选择 导引导管和导丝的放置 保护装置的放置和回收 支架的置入 大 纲 投照体位 入路的选择 导引导管和导丝的放置 保护装置的放置和回收 支架的置入 投照体位 关键点 切线位 投照体位 关键点 弓上起源 左前斜位 大 纲 投照体位 入路的选择 导引导管和导丝的放置 保护装置的放置和回收 支架的置入 入路的选择 手术入路的选择 上肢入路 右椎开口低 血管开口的角度 桡动脉 肱动脉 股动脉入路 Allen test 入路的选择 桡动脉入路 A positive Allen test When there is adequate collateral circulation to the hand from the ulnar artery and a palmar blush occurs within 5–10 seconds after releasing the ulnar artery Abe S, Meguro T, Endoh N, et al. Catheter Cardiovasc Interv. 2000;49:253–56 Puncture is best performed approximately 2–3 cm cephalad to the radial styloid Most patients can tolerate up to a 6F sheath without undue risk of radial artery injury After sheath placement, antispasm prophylaxis is performed 3 mg of verapamil into the radial artery sheath Layton KF, Kallmes DF, Cloft HJ. AJN