Wingspan支架幻灯.ppt

1、WingspanTM 支架系统 with GatewayTM 球囊颅内动脉缺血性疾病介入治疗的里程碑,Wingspan HDE 临床研究:Objectives目的,评估Wingspan和Gateway联合使用治疗ICAD所致反复发作性中风的安全性和器械性能 患者均为反复发作中风，目前无理想治疗手段 所有临床事件和血管造影均由核心医院和临床事件委员会集体评估,Wingspan HDE Study:研究设计,Wingspan HDE Study:研究终点,Wingspan HDE Study: 结果概述,多中心 路径 安全性 临床结果 半年症状性狭窄 半年50% 狭窄,12个中心 50%再前循环

2、9例M1段 操作成功率 = 97.7%(43/44) 无夹层及血管破裂 30天 同侧卒中及死亡 = 4.4% (2/45) 半年 同侧卒中及死亡 = 7.0% (3/43) 0% (0/40) 7.5% (3/40),主要结果,适应症,颅内动脉狭窄所致TIA或中风的患者,Data on file at Boston Scientific Do not copy or distribute. PSST IC 2218,低剖面 3.2F近端输送杆,可调柔韧度 PushCoil,BioslideTM 亲水涂层,锥形渐变 2.4F 远端输送杆,LEAP/SoftLEAP 半顺应性球囊 ，XTRA 涂层

3、和激光镶嵌标记,近端输送杆标记,Gateway 球囊:7大主要产品特征,Photographs taken by Boston Scientific.,Gateway 球囊: Laser Bonded TrakTip激光镶嵌头端,Gateway PTA Balloon Catheter:Semi-Compliant PTA Balloon半顺应性球囊,Gateway PTA Balloon Catheter:输送杆,Gateway PTA Balloon Catheter技术指标,WingspanTM 支架系统,WingspanTM 支架系统,设计 3内连接镍钛自膨支架 支架两端各4个锥形边缘

4、白金标志显影 主要产品特征 自膨 柔软网格构架 径向支撑力适度,WingspanTM 支架系统: 自膨支架设计,WingspanTM 支架系统 柔软网格架构,WingspanTM 支架系统径向支撑力适度,WingspanTM 支架系统径向支撑力,Bench test results are not necessarily indicative of clinical performance. Data on file at Boston Scientific.,体内径向支撑力比体外高1.6倍,WingspanTM 支架系统:输送系统,镍钛支架,WingspanTM 输送系统:内轴,双重渐细头端

5、,WingspanTM 输送系统内轴特点,WingspanTM 支架系统: 外鞘,预装旋转止血阀,WingspanTM 输送系统外鞘,Wingspan 输送系统技术指标,推荐使用附件,Femoral Access Sheath, 6F Guider Softip XF Guide Catheter, 6F .064” ID, 90 cm length StraightH965100500 MultipurposeH965100460 40 AngleH965100420 Excelsior SL-10 Microcatheter Straight, 2-tipM0031681890 Trans

6、end EX .014 Guidewires Standard, 182 cmM001468050 Soft Tip, 205 cmM001468060 Floppy, 205 cmM001468070 Platinum, 205cmM001468080,Transend 300 Guidewire, .014” diameter FloppyM003468450 Extra SupportM003468140 Rotating Hemostatic Valve (RHV) Box of 5M0014212421 Encore -26 Inflation Device Single packM

7、001151050 Box of 5M001151062,Balloon Selection: 球囊选择,球囊长度与病变长度尽量相符 球囊标称直径应与血管直径的80相符（血管直径选择病变血管近端或远端）较小的一边。 球囊充盈后直径不能超过病变血管直径,Gateway Balloon Size Chart,Gateway 球囊 在不同压力下球囊直径的变化,Sizing Example 1: Balloon,狭窄如何测量? WASID 法: 1 - (1mm/3.2mm) x 100 = 69% 狭窄 选择哪个型号的球囊？ 直径: 80% is 0.8 x 3.0mm = 2.4mm in dia

8、meter Balloon diameter should be 2.25mm 长度: Recommended length: match lesion length Length should be 9mm 选择: 2.25mm x 9mm,3.2mm,MLD = 1 mm,5.0mm,Illustrative,3.0mm,Balloon Sizing Review: Example 2,直径: 80% is 0.8 x 3.5mm = 2.8mm in diameter Balloon diameter should be 2.75mm 长度: 9 or 15mm 在HDE Study中,

9、 如果血管直，则选择较长的球囊 如果血管弯曲，则选择较短的球囊，充盈两次 选择: 2.75 x 15mm (if straight vessel) or 2.75mm x 9mm (if curved vessel),4.2mm,MLD = .7 mm,12.0mm,Illustrative,3.5mm,Balloon Sizing Review: Example 3,直径: 80% is 0.8 x 3.0mm = 2.4mm in diameter 可选: 2.25mm 2.5 if inflate to 4atm (使用球囊充盈表做为参考) Dr. Arani Bose 倾向使用小球囊和

10、略高一点的充盈压 8atm 长度: 9mm 选择: 2.25mm x 9mm or 2.5mm x 9mm,3.2mm,MLD = 1 mm,5.0mm,Illustrative,3.0mm,Wingspan 支架大小选择,Stent Diameter,Stent 选择 支架长度应超越病变各3mm. 支架总长度至少大于病变长度6mm 直径选择以病变血管近端为准,注意: 球囊与支架型号不可能一样！,Sizing Example 1: Stent,What size stent? 直径: Size to parent vessel, whichever is larger Largest pare

11、nt vessel is proximal, 3.2mm Choose 3.5mm diameter Length: Allow for at least 3mm on either side of lesion Choose 15mm length Size Choice: 3.5 x 15mm,3.2mm,MLD = 1 mm,5.0mm,Illustrative,3.0mm,Sizing Example 2: Stent,What size stent? Diameter: Size to parent vessel, whichever is larger Largest parent

12、 vessel is proximal, 3.1mm Choose 3.5mm diameter Length: Allow for at least 3mm on either side of lesion Choose 15mm length Size Choice: 3.5 x 15mm,3.1mm,MLD = 0.9 mm,8.0mm,Illustrative,2.8mm,Sizing Example 3: Stent,What size stent? Diameter: Size to parent vessel, whichever is larger Largest parent v