颈动脉支架置入术教学PPT课件.ppt

脑保护装置 支架类型 球扩式支架 Palmaz Stent (Cordis) 自膨式支架 Carotid Wallstent (Boston Scientific) PRECISE (Cordis) Protégé (ev3) Acculink (Abbott） 自膨式支架 雕刻支架 编织支架 编织支架 优点 支撑力更大,不易塌陷 柔韧性更强，表面光滑，易于球囊通过 网孔密集，限制斑块脱落 可重新定位、再次释放 编织支架 不足 短缩、不易精确定位 拉伸颈动脉、上端扭曲、成角 凹凸不平处贴壁欠佳 雕刻支架 优点 顺应性好，适应不同形状而不造成血管强直 贴壁性好，不易造成死腔 基本无缩短，定位和选择长度较精确 不足 后扩时有连接点断裂的风险 支架选择 支架直径 (完全张开) 必须至少比最大的目 标血管大 1 mm 目标血管：CCA 支架长度：两端至少超过狭窄 0.5～1 cm ， 并覆盖“健康” 动脉 如果颈动脉狭窄累及分叉处，则支架至少 要放 1 cm 在颈总动脉 支架选择 颈动脉迂曲不明显及狭窄边缘较光整时，选用Wallstent或雕刻支架均可 颈动脉迂曲较明显时，雕刻支架的柔顺性和贴壁性较好 高危斑块（软斑块）宜选用Wallstent 如果必须处理颈外动脉病变，则只能选用Wallstent，以便在Wallstent的网眼中进行扩张 颈动脉支架置入术 颈动脉支架置入术 External Carotid Artery Internal Carotid Artery Common Carotid Artery External Carotid Artery Internal Carotid Artery Common Carotid Artery Terumo guidewire 0.035” 100cm Headhunter 5F Tempo 200cm INTRODUCE GUIDEWIRE AND INTRODUCER SHEATH External Carotid Artery Internal Carotid Artery Common Carotid Artery Terumo guidewire 0.035” 100cm Headhunter 5F Tempo 200cm INTRODUCE GUIDEWIRE AND INTRODUCER SHEATH External Carotid Artery Internal Carotid Artery Common Carotid Artery SELECTIVE CATHETHETERISATION OF ECA Terumo guidewire 0.035” 100cm Headhunter 5F Tempo 200cm External Carotid Artery Internal Carotid Artery Common Carotid Artery Headhunter 5F Tempo 200cm EXCHANGE GUIDEWIRE Terumo guidewire 0.035” 100cm External Carotid Artery Internal Carotid Artery Common Carotid Artery Headhunter 5F Tempo 200cm EXCHANGE GUIDEWIRE External Carotid Artery Internal Carotid Artery Common Carotid Artery Headhunter 5F Tempo 200cm EXCHANGE GUIDEWIRE Amplatz Emerald 0.035” 260cm External Carotid Artery Internal Carotid Artery Common Carotid Artery Amplatz Emerald 0.035” 260cm EXCHANGE INTRODUCER SHEATH External Carotid Artery Internal Carotid Artery Common Carotid Artery Amplatz Emerald 0.035” 260cm Brite Tip Sheath 7F 80cm EXCHANGE INTRODUCER SHEATH External Carotid Artery Internal Carotid Artery Common Carotid Artery Brite