冠状动脉介入治疗球囊的选择课件

1、冠状动脉介入治疗球囊的选择徐州中心医院吴强编辑ppt球囊分类整体交换球囊（OTW- over the wire)快速交换球囊 (monorail)Rapid ExchangeGuidewireInflation lumen& guidewire lumenInflation lumen onlyInflation portOver-the-WireGuidewireInflation lumen& guidewire lumenInflation Port编辑ppt球囊的结构球囊尖端球囊 推送杆编辑ppt球囊尖端外径：直头圆弧锥形尖端与球囊的连接：胶水黏结热焊接激光焊接编辑ppt编辑ppt编辑

2、ppt球囊球囊材料：尼龙、聚乙烯球囊顺应性（顺应性/半顺应性/非顺应性）（顺应性=球囊直径/压力atm）折叠方式：零折叠、二折叠三层折叠：利于回卷，后撤，低折叠减小通过半径。标记方式：中央标记易于通过严重狭窄病变，双标记利于测量病变长度，与内杆关系（外包/内嵌）球囊肩部角度：球囊于尖部平滑过渡有利于通过病变球囊与中心杆的连接技术和材料：决定通过扭曲血管的能力球囊表面亲水涂层有利球囊的通过性。编辑ppt开辟新纪元的零折叠技术零折叠两折叠没有折叠的球囊材料球囊材料直接裹在远端球囊杆上，加压充盈 成为一个球囊编辑ppt编辑pptSprinter 1.5mmSprinter Legend 1.25&1

3、.5mm 金标记带在外杆上标记带处的球囊外径在同类产品中最小（0.024”）Sprinter Legend 1.25&1.5mm球囊标记带改放在球囊内杆上铂金加銥标记带在内杆上编辑ppt编辑ppt球囊性能外径（crossing profile)灵活性（flexibility)跟踪性（trackbility)推送性（pushbility)顺应性（compliance)编辑ppt球囊操作要领编辑ppt预扩张有利于支架的植入有利于病变的测量选择小于血管直径0.5-1mm的球囊进行预扩张，球囊长度应适当预扩张应尽量减少对正常血管的损伤，因此，大直径高压力只在必要时使用。为测量病变长度，使预扩张球囊在冠

4、状动脉内进行造影时，注射造影剂的力度不宜过大，以免加重血管的撕裂对于狭窄程度重、较复杂的病变，预计支架通过较困难的病变应常规充分地预扩张，尤其对初学者编辑ppt预扩张中的问题球囊的通过性：严重的狭窄、钙化病变，闭塞病变（球囊选择、双导丝、锚定、Tornus、旋磨)。球囊的扩张效果：钙化病变，较硬纤维斑块（切割、旋磨、双导丝+高压囊）。编辑ppt血管内超声（IVUS）: 血管钙化编辑ppt不同类型病变的球囊选择 小血管病变：宜选用外形小，推进性好的球囊。还可选用耐高压球囊。扭曲病变：应选择外形较小、推进性好的球囊。OTW球囊推进性较单轨球囊好，还有利于交换导丝钙化病变：应选择外形较小、推进性好的

5、球囊。还可选用双导丝、耐高压乳突或切割球囊，两根导丝加高压球囊，旋磨后球囊扩张。 编辑ppt后扩张防止支架贴壁不良，预防支架内血栓形成，降低再狭窄后扩张球囊可选择大一号的球囊或更高的压力后扩张时一定不能超出支架的边缘，尤其是的DES不可盲目追求所有病例的大球囊高压力的后扩张，以免增加无再流和冠状动脉破裂的风险编辑ppt不同类型病变的球囊选择 CTO 病变：常选择单标记、整体交换、小外径（1.5-1.25-1.0 mm）球囊，如Maverick Sprinter Legend等长病变：原则上选用较长的球囊，以防两端撕裂并减少扩张次数。分叉病变：可选双导丝球囊、切割球囊。目的：减少斑块移位、降低分

6、支闭塞的概率。 编辑ppt常用的球囊特点编辑pptMaverick PTCA Balloon CathetersProprietary laser bonded technology creates an extraordinary TrakTip Design and precise, smooth bonds throughout the shaft. Push coil design and improved distal flexibility for enhanced trackability. Our 1.5 and 2.0 mm SoftLEAP Balloons offer e

7、nhanced crossability. 编辑pptApex PTCA Dilatation CatheterSlope Outer Shaft smoothly transitions from stiff to flexible, all in one piece, for more efficient push transmission Bi-Segment Inner Shaft optimizes the balance between push and track Shorter, thinner marker bands increase distal flexibility

8、Redesigned tip with improved flexibility and wire movement; same ultra-low 0.017 profile OptiLEAP Balloon with reduced waist thickness provides great sizing flexibility with lower profiles Nano-composite materials adds structure and pushability to the outer shaft 编辑pptQuantum Maverick BalloonLow pro

9、file, full length 1.8F or 2.0F Monorail shaft Low profile 3.2F proximal over-the-wire shaft Bioslide Coating on a PEBAX Distal Shaft Laser bonding technology Quantum LEAP Balloon Material Tapered TrakTip Design with .017 lesion entry profile* 编辑ppt编辑ppt编辑ppt编辑pptNC sprinter外形细小的FasTrac头端技术-可在遇到 较难通过

10、的病变时提供极佳的通过能力；柔软耐用的Fulcrum Plus球囊材料和MiniWrap 折叠技术提供细小的外径和出色的再回抱能力；选择性的Dura-Trac涂层使球囊在到达和通过 病变的过程中保持持久的润滑，在球囊扩张 时保持稳定；渐细钢丝设计的推送杆增强了球囊的跟踪能 力和通过远端病变能力；光滑细小的导丝交换口使3.5mm以下的任何 两个球囊可在6F（0.070）的指引导管里对吻。编辑pptSunflex Tip is superbly engineered to give a perfect balance between flexibility and kink resistance.

11、 Zero transition between the tip and wire for smoothest entry profile.Tapered Tip:The tapered soft tip combined with advanced laser welding technology provides the most competitive tip profileSlidematrix dual coating is specially formulated with two unique proprietary blends. Hydrophilic and Invio c

12、oatings are applied to the distal leading tip section and the balloon/shaft section, respectively to provide an optimal balance between lubricious crossing and minimizing watermelon seeding Tight Fold processing results in a slender primary profile for enhanced crossability through tight lesions. Sa

13、pphire NCOrbusNeich 编辑pptThe IP Transition Zone of the Avita PTCA Dilatation Catheter provides intensified pushability. The new tapered tip design with soft material exhibits a flexible tip for smooth lesion entry and minimal vessel trauma. The Invio coating on the inner lumen eliminates friction be

14、tween the catheter and guidewire. Invio is also applied to the outer distal segment from the tip to the exit marker zone for lubricious crossability. Avita HPOrbusNeich 编辑pptRuginCrossTipTM 确保Ryugin通过性可以达到的最高性能。CrossTipTM 是由特殊混合的弹性塑料聚合物制作而成。0.017 英寸(0.043毫米)的入口外径确保了Ryugin 在完全闭塞的病变的复杂管腔里的通过性。CrossTip

15、TM 中等长度的柔韧前端能较易地通过移植支架处的病变并绷紧其钙化病变。 亲水涂层M-Coating，塑料聚合物的复合层和新一代金属合金的Hypotube。使用Ryugin通过过度弯曲和大弯曲血管时，它能顺滑的到达目标病变部位，并且成功的处理其复杂闭塞病变。提供广泛有效的球囊直径选择范围从超细的1.25毫米直径到4.0毫米直径不等。薄型聚酰胺球囊确保了其卓越的通过性Ryugin CrossTip 是从尖端到薄型聚合物球囊的一段平滑过度部分，平滑柔韧的联合体能够通过各种复杂病变部位。泰尔茂新一代FC(Flexible Corrugate) 轴管成为连接高弹性的前端轴管和具备强硬金属的Hypotub

16、e 轴管之间的桥梁。 FC-shaft 是指经过加工的柔软的胶质轴，该技术实现了通过一个平衡轴加强力量的传输性和弹性。 编辑pptVoyagerSuperb Cross Tapered Tip DesignNew tapered tip with .017” tip entry profile designed to cross tight lesions Improved tip-to-wire conformability1 for confident track and cross Polyurethane tip material is flexible yet durable for

17、 tough lesions Flexible tungsten marker technology allows catheter to conform to tortuous anatomy More Options Low Profile Shaft DesignVersatile treatment in a 6F guide Excellent track and push in tortuous anatomy with new hypotube design Reinforced mid-shaft design provides flexibility and addition

18、al support Flexibility with Visibility Proprietary Tungsten MarkerNew marker material comprised of tungsten polymer Flexible marker design allows the catheter to conform more easily to tortuous anatomy Increased marker flexibility helps to reduce resistance when crossing tight lesions Precise Dilata

19、tion Proven Balloon PerformanceShort tapers allow for precise dilatation Improved LOFOLD Balloon Technology processes allows for excellent rewrap and recross1 XCELON S Balloon Material achieves superb flexibility 编辑pptPowersailPLATEAU Balloon MaterialProvides non-compliance at high pressure without

20、compromising performance Flexibility and conformability for excellent deliverability LOFOLD Balloon TechnologyProvides a low crossing profile for exceptional lesion cross LOFOLD balloon technology for improved balloon rewrap Soft Tip DesignTapered tip design creates a low entry profile and excellent

21、 tip-to-wire conformability for easy lesion access Soft tip provides flexibility for negotiating tortuosity and crossing stent struts Dual Swaged MarkersProvide lower profiles than conventional markers 编辑ppt为复杂病变设计的MINI TREKMINI TREK独特的小底盘设计提供1.20 mm, 1.50 mm和2.00 mm 的球囊编辑pptSafeCut uses dual wire m

22、echanism to create focused force. It has a built-in 0.011 integral wire external to the balloon to help track tortuous vessels with great efficiency. A standard 0.014 guidewire that delivers the catheter to the target lesion also participates in the dilatation process. The guidewire exit port is loc

23、ated at the proximal part of the balloon. During balloon dilatation, the standard guidewire and integral wire apply controlled force to facilitate plaque fractures at low inflation pressures. The same application also helps minimize balloon slippage. SafeCuts distal leading tip profile is 0.032 tape

24、red to 0.028 which is smaller than those of other focused force balloons. Balloons with embedded blades for scoring the vessel have high crossing profiles due to the nature of the balloon materials and blades. The integral wire and standard guidewire apply evenly distributed force to facilitate controlled plaque at low pressures, reducing