（参考课件）CTO导丝.ppt

CTO导丝的选择,中山大学附属第一医院杜志民,1,CTO导丝的选择,CTO病变的特点CTO正向导丝通行技巧导丝的基本结构几种新导丝的特点,2,30-50%CTOwithMicro-channels,3,CTO导丝的选择,CTO病变的特点CTO正向导丝通行技巧导丝的基本结构几种新导丝的特点,4,5,钻行技术,6,穿行技术,7,滑行技术,8,9,10,11,CTO导丝的选择,CTO病变的特点CTO正向导丝通行技巧导丝的基本结构几种新导丝的特点,12,13,14,15,16,17,18,PolymercoverwithHydrophilicCoating,HydrophilicCoating,HydrophobicCoating,NoCoating,19,20,21,CTO导丝的选择,CTO病变的特点CTO正向导丝通行技巧导丝的基本结构几种新导丝的特点,22,几种滑导丝,23,24,FielderFC&FielderXT,0.009”,25,FielderFC,26,FielderX-treme,16cm显影的弹簧圈段,16cm聚合物包裹及涂层,0.014”,不锈钢核心,0.009”,XT-AXT-R,27,BeforeShaping,AfterShaping,28,29,PTFEcoating,Ropecoil&Radiopaquesegment3cm,TIPLOAD:0.5G,30,GW直径；0.026mm(0.010”)有效长度；330cm弹簧圈长度；80mm（Pt：SUS=30mm：50mm）亲水涂层长度；1700mm头端负荷；3g,31,ProductInformation,32,33,CoreTechnologiesinWireDesign,Drawing,Torque,+,WireForming,Torque,+,Coating,Core,Coil,GuideWire,34,Structure,Radiopaquelength：3cmCoatinglength：28cm（Fullcoating）Tipload：0.7g,Joint-lessspringcoil,CompositeCore,35,ACTONE,Coil,Twistcore,Corewire,CompositeCore,SixwireropeHollowtube,36,Coil,Corewire,CompositeCore,Twistcore,37,CompositeCore,TheCompositeCoreImprovesTorqueandTipShapeRetention1TipbreakageKinkinCorewireACTONEprotectstheCorewire2PreventsTorque“Whip”Preventswhipbystoppingtorquebuild-up,38,CompositeCore,ACTONEbenefits1Shapeprotection2Torquetransmission,Twistcorebenefits1StrongertipCompositeCoreallowsforasmallerdiametercorewire2Negates“whipping”,几种硬导丝,39,40,41,42,43,44,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEPROGRESS:新一代慢性闭塞病变导丝,不锈钢,聚合物护套/混合涂层,穿透力,高性能,标准,穿透力低,穿透力高,TestsperformedbyanddataonfileatAbbottVascular,CROSS-IT400XT,AsahiConfianzaPro9|12,AsahiFielderXT,HTPILOT50|150|200,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,3cmradiopaquecoil,29.5cmpolymersleeve,TestsperformedanddataonfileatAbbottVascular,SMOOTHGLIDE:疏水涂层有助于器械在导丝的近段移动,TURBOCOAT:亲水涂层使导丝远段在长时间手术过程中保持润滑,头端直径:0.012”(40,80,120)0.0105”(140T,锥形)0.009”(200T,锥形),中段聚合物护套覆盖亲水涂层:使导丝在病变中具有最大的可操控性,CORE-TO-TIPDURASTEEL:高强度的核芯材质和核芯至头端设计提供了出色的扭控反应和导丝的保持塑形能力,RESPONSEASE:距离导丝头端12cm无过渡节段的核芯避免了脱垂点的产生最大幅度地减少了导丝打折，并提供可靠的导丝操控,头端弹簧圈:5mm裸露头端便于产生触觉反馈,引领慢性闭塞病变导丝技术:HI-TORQUEPROGRESS系列导丝,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEPROGRESS系列导丝,HI-TORQUEPROGRESS40其特点为具有保持塑形的头端，是探索或滑行的理想器械,HI-TORQUEPROGRESS80头端设计便于滑行或钻行,HI-TORQUEPROGRESS120提供更硬的头端以便钻行,HI-TORQUEPROGRESS140T锥形头端(0.0105”)便于穿刺慢性闭塞病变,HI-TORQUEPROGRESS200T具有0.009”直径的头端以便穿刺慢性闭塞,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEPROGRESS临床技术,滑行技术:通过功能性闭塞病变或者非常狭窄的病变时的常用技术，采用光滑的聚合物护套导丝可获益.,HI-TORQUEPROGRESS40(4.8g,.012”tip),HI-TORQUEPROGRESS80(8.9g,.012”tip),钻行技术:通过轻柔的动作前送导丝。直头导丝有助于保持触觉反馈和操控性。可以升级到更硬的导丝。,HI-TORQUEPROGRESS120(13.9g,.012”tip),HI-TORQUEPROGRESS140T(12.5g,.0105”tip),穿行技术:瞄准目标后使用导丝穿刺闭塞段。导丝的方向需要更为精确的控制。锥形头端的导丝具有更高的穿透力。,HI-TORQUEPROGRESS140T(12.5g,.0105”tip),HI-TORQUEPROGRESS200T(13.0g,.009”tip),HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEPROGRESS慢性闭塞病变治疗的突破：穿透力,Note:drawingnottoscale,头端硬度/导丝头端面积.004kg/(3.14*.006”2)穿透力=40,导丝头端,导丝头端面积,r,头端直径0.012”,头端硬度=4.0g,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEPROGRESS系列导丝,HI-TORQUEPROGRESStiploadvaluesbasedonnewAVTipLoadtest,TestsperformedbyanddataonfileatAbbottVascular,HI-TORQUEPROGRESS40(4.8g,.012”头端),HI-TORQUEPROGRESS80(9.7g,.012”头端),HI-TORQUEPROGRESS140T(12.5g,.0105”头端),HI-TORQUEPROGRESS200T(13.0g,.009”头端),100,200,150,50,HI-TORQUEPROGRESS120(13.9g,.012”头端),穿透力,“T”=锥形,穿透力,HI-TORQUEPROGRESSGuideWireIn-ServiceforOUSLT2929781RevG2010AbbottLaboratories.InformationcontainedhereinfordistributionoutsideoftheUS&Japanonly,HI-TORQUEProgress设计优点穿透力,采用穿透力便于慢性闭塞导丝的直接比较,TestsperformedbyanddataonfileatAbbottVascular,Kg/inch,导丝的选择,AlwaysstartwiththesoftwiresQuicklyupgradetostifferwiresinastepupstrategy,As30-50%CTOwithMicro-channelsAsmicro-channelsaresometimesnotvisible,52,导丝的选择Whichwireandwhen？,Micro-cha