腦血管介入常用材料

1、腦血管病介入治療常用材料,臨沂市人民醫(yī)院腦血管病診療中心,上海微創(chuàng)Microporthttp://www.microportmedical.com,,APOLLO 顱內(nèi)動脈支架系統(tǒng)Intracranial Stent System,產(chǎn)品簡介：APOLLO顱內(nèi)動脈支架系統(tǒng)由上海微創(chuàng)研制，是目前國內(nèi)首個應(yīng)用于腦動脈血管的支架系統(tǒng)。顱內(nèi)動脈支架系統(tǒng)由顱內(nèi)動脈支架和輸送器組成。支架采用316L不銹鋼，經(jīng)激光切割而成。,APOLL

2、O 顱內(nèi)動脈支架系統(tǒng),產(chǎn)品特點 1）支架結(jié)構(gòu)采用正弦波的開放設(shè)計，并由一對“n”型連接鍵 呈空間“u”形連接，每組空間“u”形連接呈90度軸向交錯排列，使支架具有優(yōu)秀的柔順性。2）正弦波的加強(qiáng)環(huán)結(jié)構(gòu)支架保持支架徑向支撐力而降低金屬覆蓋率。3）特殊的“鏡面”拋光技術(shù)，提供無可挑剔的支架表面質(zhì)量。4）特殊的支架壓握技術(shù)，突出輸送過程的安全性，并使輸送系統(tǒng)保持較小的截面積，完成高難度手術(shù)操作。,APOLLO

3、0;顱內(nèi)動脈支架系統(tǒng),產(chǎn)品規(guī)格,主要技術(shù)指標(biāo) 1. 支架厚度為0.0040inch2.支架金屬覆蓋率Ф2.5時為 13.60%3.支架擴(kuò)張后短縮率＜3%，徑向回彈率＜4%4.支架名義擴(kuò)張壓力為6atm，爆破壓12atm5.支架壓握后直徑0.0365in. ~ 0.0391in.,*最小導(dǎo)引導(dǎo)管的內(nèi)徑為5F*導(dǎo)引導(dǎo)絲直徑為0.014inch,Runner2球囊擴(kuò)張導(dǎo)管,,柔軟、新型的超軟端設(shè)計提高了導(dǎo)管的跟蹤性能和

4、穿越病變的能力，降低損傷血管壁的風(fēng)險。 應(yīng)用國際先進(jìn)水準(zhǔn)的新型高分子材料FANTAX® 。 凹陷型的顯影點安裝方式，減小了球囊折疊后的外徑尺寸和顯影點對球囊的損傷。,產(chǎn)品規(guī)格及主要技術(shù)指標(biāo),產(chǎn)品規(guī)格及主要技術(shù)指標(biāo),SATURN遠(yuǎn) 端 保 護(hù) 器 Distal Protective Device,骨架選用了激光切割鎳鈦（NITI）合金。 遠(yuǎn)端保護(hù)器的主要構(gòu)成是一個帶有傘狀濾網(wǎng)的0.014“導(dǎo)絲，濾網(wǎng)膜由高分子材料制成，上

5、有大量0.1毫米微孔。 傘狀濾網(wǎng)預(yù)裝在熟料外鞘管中，鞘管有側(cè)孔與帶濾網(wǎng)導(dǎo)絲配合呈快速交換結(jié)構(gòu)。,,,產(chǎn)品分類標(biāo)記及技術(shù)規(guī)格,北京樂普http://www.lepumedical.com/,,同心PARTNER雷帕霉素藥物洗脫支架系統(tǒng),使用雷帕霉素藥物制劑具有良好的生物相容和緩釋特性，能夠確保臨床使用的安全性和有效性。采用雙螺旋結(jié)構(gòu)的設(shè)計提供強(qiáng)有力的血管支撐力，使支架能保持良好的支撐和貼壁性能，尤其在分叉開口完全閉塞鈣化等病變中表現(xiàn)

6、優(yōu)異的性能。 支架品種規(guī)格長度由12~36mm 直徑由2.5~4.0mm規(guī)格型號齊全能夠適用不同病變的臨床要求。,主要技術(shù)指標(biāo),支架材質(zhì) AISI 316L醫(yī)用不銹鋼支架厚度為0.0045inch支架表面積 15-18%縮短率為 小于1%回彈率為 小于2%徑向抗壓 大于16psi球囊導(dǎo)管有效長度 1350mm支架預(yù)裝后直徑 0.95-1.1mm支架擴(kuò)張后直徑 2.50-4.00mm支架長度 12-36mm球囊允許壓

7、力 16atm球囊導(dǎo)管結(jié)構(gòu) 導(dǎo)絲快速交換型涂層厚度 6μm 藥物劑量 1.2μg/mm2,佳騰guidanthttp://www.guidant.com/,,RX ACCULINK? Carotid Stent System,Self-expanding nitinol6F sheath/8F guide catheter Diameters: straight5.0, 6.0, 7.0, 8.0, 9.0, 10.0 mm

8、 tappered 6-8mm,7-10mmlengths :20, 30, 40 mm 014" low-profile system Compatible with 100 cm guiding catheters and sheaths,Stent Configurations,Material: Self-expanding NitinolStent lengths

9、: 20, 30*, 40*mmStent diameters:Straight: 5-10 mmTapered: 6*8 mm, 7*10 mm,Stent Designed for Accurate Placement3 longitudinal spines reduce shorteningOnly 1.0% foreshortening1Unique Handle DesignDesign enables one

10、 hand deploymentEliminates “push-pull” techniquePlaced on table or leg, stabilizing system for accurate placement,Designed for Accuracy,1 Measured using 7X40mm ACCULINK stent. Tests performed by and data filed at Guida

11、nt.,RX ACCUNET? Embolic Protection System,6F sheath/8F guide catheter compatible 4.5, 5.5, 6.5, and 7.5 mm basket diameters recommended for use in arteries ranging from 3.25 mm to 7.0 mm 0.014” guide wire based 190 c

12、m and 300 cm lengths,,Polyurethane filter over nitinol basketMaintains perfusion Artery range Basket Profile 3.25 mm – 4.0 mm 4.5 mm 3.5F 4.0 mm – 5.0 mm 5.5 mm 3.5F 5.0 mm – 6

13、.0 mm 6.5 mm 3.7F 6.0 mm – 7.0 mm 7.5 mm 3.7F,Excellent Deliverability,Guide wire and delivery sheath enter vessel as one unit Highly flexible to navigate tortuous anatomy Low profile and smooth transition f

14、rom tip to filter basket .014” wire is torqued independent from filter basket,Delivery Sheath Tip,Accurate Deployment,Rapid exchange unsheathing for stability and simplicity Peel away delivery sheath allows for control

15、led deployment,Peel away Convertible Sheath,Capture and Control for Optimal Protection,Highly flexible filter basket designed to conform to tortuosity Designed to capture high volume while allowing adequate blood flow

16、Concentric design with guide wire centered in filter Four platinum radiopaque markers surround filter for visualization of wall apposition,Effective and Flexible Filter,Secure Filter Retrieval,Choice of two rapid exchan

17、ge recovery catheters designed specifically for the challenges of filter recovery,RX ACCUNET? Recovery Catheter Shapeable Recovery Catheter Tip,RX ACCUNET? 2 Recovery Catheter,Low-profile, flexible tip to allow for defl

18、ection away from stent struts during advancement Flexible catheter/shaft optimized for challenging guide catheter/sheath access Catheter shaft markers at 95 and 105 cm for reduced flouro time,,美國美敦力公司(Medtronic,Inc.)

19、http://www.medtronic.com,,GuardWire® Temporary Occlusion and Aspiration System,,GuardWire Ordering Information,,Racer Over-the-Wire Biliary Stent System,,,波士頓科學(xué)公司(Boston Scientific Corp) http://www.bostonscientific

20、.com,,亞太地區(qū)產(chǎn)品,Carotid Wallstent® Monorail? Stent FilterWire EX? NexStent® Carotid Stent Wingspan® Stent System with Gateway? PTA Balloon Catheter,Wingspan® Stent System with Gateway? PTA Balloon Cat

21、heter,3.5F Over-the-Wire (OTW) Stent Delivery System0.014 in Guidewire Compatible6F Guide Catheter CompatibleStent diameter:2.5,3.0,3.5,4.0,4.5mmStent length:9,15,20mmBalloon length:15,20mmBalloon diamaeter: 1

22、5mm-1.5,2.0,2.25,2.5,2.75mm 20mm-1.5,2.0,2.25,2.5,2.75,3.0 3.25,3.5,3.75,4.0mm,Wingspan Procedure Overview,Gentle Pre-Dilation (6 atm ): undersized to 80% of the target vessel diameter Atraumatic

23、 Stent DeploymentHighly Conformable Stent DesignOutward Radial Force,NexStent® Carotid Stent,nitinol stent system Low-profile, 0.014" Monorail® Delivery SystemStent Length:30mm diameters from 

24、60;4mm-9mm (Dynamic Tapering? Technology)Self-sizing, flat-sheet nitinol roll design acts as a tapered or straight stent,  accommodating vessel diameters from 4mm-9mm,FilterWire EZ? Embolic Protection System,F

25、ilterWire EZ? Embolic Protection System,,FilterWire EZ? Embolic Protection System,1.   Radiopaque Spring Tip (3.0 cm)2.   Polyurethane Filter (110 micron pore size)3.   Radiopaque Nitinol

26、Loop4.   Spinner Tube5.   Proximal Stop6.   PTFE Coated Wire (.014"),FilterWire EZ? Embolic Protection System,6F Guide Catheter Compatible (minimum ID .066”)3.5—5.5 mm Vessel Diamet

27、er Protection,WALLSTENT® Endoprosthesis,Wallstent® Iliac Endoprosthesis with Unistep? Plus Delivery SystemSelf-expanding 支架直徑：6 7 8 9 10 mm支架長度：18~69mm導(dǎo)管直徑：6F導(dǎo)管長度：100 160cm,,TAXUS® Express²? Pacl

28、itaxel(紫杉酚)-Eluting Coronary Stent System,,Neuroform3? Microdelivery Stent System,,強(qiáng)生cordishttp://www.cordis.comhttp://www.jnjgateway.com,,Cordis系列支架,PALMAZ GENESIS Transhepatic Biliary Stent  PALMAZ Transhepatic

29、 Biliary Stent PALMAZ BLUE Transhepatic Biliary Cobalt Chromium StentPRECISE RX Transhepatic Biliary Stent  PRECISE Transhepatic Biliary Stent S.M.A.R.T. CONTROL Transhepatic Biliary Stent S.M.A.R.T. Transhep

30、atic Biliary Stent 12mm & 14mm,5.5F and 6F crossing profile. 135cm catheter working length. 0.014” and 0.018” guidewire acceptance. 5F proximal shaft.DIAMETER: 5,6,7,8,9,10mm LENGTH:20,30,40mm,Cordis PRECISE®

31、 Nitinol Self-Expanding Stent,Cordis ANGIOGUARD® Capture Guidewire,Eight Nitinol struts. Available in medium and extra support. 100 micron basket pore size.,Angioguard 規(guī)格-選用,傘直徑血管徑釋放鞘回收鞘 4mm3.0-3.5 3.2F

32、 5.1F 5mm3.5-4.5 3.3F 5.1F 6mm4.5-5.5 3.5F 5.1F 7mm5.5-6.5 3.7F 5.1F 8mm6.5-7.5 3.9F 5.1F,,,,Angioguard,,,,SV .018" Guidewire,Steerability and Support high level of support a

33、nd torque response,,EMERALD® Guidewires,Shaping the way you approach diagnostic proceduresEnhanced maneuverabilityReduced likelihood of flakingFinger Straightenability,Braided Angiographic Catheter,Superior torqu

34、e response for fast and easy catheter positioning Excellent pushability and kink resistance Soft flexible atraumatic tip for enhanced trackability Tapered tips for sheathless entry,Ev3 http://www.ev3.net,,SpideRXTM E

35、mbolic Protection Device,Use of preferred 0.014" - 0.018" Guidewire - to reach and cross the lesion Single Dual-Ended Low-Profile Catheter - one end for delivery and the opposite end for recovery Pre-Loaded F

36、ilter/Capture Wire - ready to flush and deploy with no stylet or introducer Fully Rapid Exchange - for primary wire, delivery and recovery of Capture Wire 6 Fr. Guide Catheter Compatible - for all SpideRX Filter sizes

37、Low 3.2 Fr. Crossing Profile - minimal interaction with the lesion during placement Multiple Filter Sizes (3.0, 4.0, 5.0, 6.0, 7.0 mm) - optimal matching of the Filter to the vessel size Longitudinal/Rotational Wire M

38、ovement - Filter designed to remain stationary during the intervention Patency Up to 60 Minutes - HEPROTEC? heparin-coated Filter,,,use in the iliac or subclavian arteries EX.P.R.T. (Exact Placement Release Technology)

39、 Release for Accurate Stent Placement Enhanced Radiopacity ：Tantalum markers Diamater:6,7,8,9,10mmLength:20,30,40,60,80mmIntroducer sheath:6F,7FGuidwire acceptance:0.018”,0.035”,6 Fr/.014” Rapid ExchangeSimple

40、, intuitive stent delivery systemCustomized delivery catheter with radiopaque mid-marker band on tapered design Diamater:straight-6,7,8,9,10mm tapered-8*6mm,10*7mmLength:straight-20,30,40,60mm

41、 tapered-30,40mm,,意大利invatec http://www.invatec.com/tool/home.phphttp://www.invatec-china.cn/,,MO.MA腦保護(hù)裝置近端血流阻斷,Mo.Ma protects the brain from embolization by two highly compliant atraumatic balloons, block

42、ing antegrade blood flow from the CCA (Common Carotid Artery) and retrograde blood flow from the ECA (External Carotid Artery): protection is established before the critical phase of lesion crossing.,美國雅培http://www.abbo

43、tt.com/http://www.abbottvascular.com,吞并了guidant的血管內(nèi)產(chǎn)品業(yè)務(wù),Xact Carotid Stent System,Nitinol constructionRapid exchange delivery system Straight and tapered configurationsStent Length:Straight-20,30mm

44、 Tapered-30,40mmStent Diameter: Straight-7,8,9,10mm Tapered-8*6,9*7,10*8mm,Emboshield Cerebral Embolic Protection System,0.014” Bare Wire with 0.018” tip 7F guide catheter/6F sheath co

45、mpatible 3.7-3.9F Filter Delivery System Rapid Exchange SystemDiameter:3,4,5,6mmCrossing Profile:3.7F,3.9F,德國phytishttp://www.phytis.com.br/sidebranching.htm,,The Phytis Diamond Sidebranch Stent,two cells designs in

46、 the same stent coated with a unique Diamond-Like Carbon (DLC) coating 13mm stent with the larger cell structure located in the middle of the stent17mm stent available in two versions, proximal and distal larger cell

47、structure .,,Stent Material: 316LStainless Steel with Diamond-Like Carbon (DLC) coatingRapid exchange hypo-tube delivery catheterNomial Pressure :8 atmRated Burst pressure:16 atmGuide wire lumen:0,014"(max) len

48、ghts:9, 12, 16, 20 e 25 mm,法國愛沙卡特公司HEXACATH,http://www.hexacath.com/,TITAN2支架,Made of stainless steel coated with Titanium-Nitride-Oxide TITAN2 BAS (Bio Active Stent) is the unique alternative to DES (Drug Eluting Stent

49、)獨特的氮氧化鈦（TiNO）涂層，降低再狹窄和支架內(nèi)血栓，不需要長期雙重抗血小板。 Widest range of coronary stents available today covering all physicians needs from 7mm to 28mm in length and from 2.0 to 5.0 in diameter. rapid exchange,Stent rangeLengths: 7

50、, 10 and 13 mmDiameters: 2.0 and 2.25 mm ProfileOne of the lowest profile available down to 0.92 mm or 0.036" opening new crossability perspectives to physicians. Metallic surface areaDesigned to decrease the m

51、etal to artery ratio, the TITAN2 X-Small stent offers an optimised coverage of 18% and 17% for vessels of 2.0 and 2.25 mm.,Stent rangeLengths: 13, 16 and 19 mmDiameters: 4.5 and 5.0 mm ProfileLower stent profile and

52、a 1.9F shaft delivery catheter combined into a high performance coronary stent system reducing friction and risk of gas embolism. Metallic surface areaThe TITAN2 X-Large stent design provides better scaffolding for ste

53、nting in large or SVG vessels. Ratios of 18% and 17% in 4.5 and 5.0 mm diameters mean better support throughout the stented area.,日本泰爾茂TERUMOhttp://www.terumomedical.com/http://www.terumo.com.cn/,,常用術(shù)語英文縮寫,PTA Percutan

54、eous transluminal angioplasty CAS Carotid angioplasty and stentingCEA Carotid endarterectomyatm atmosphere 大氣壓 101.3kPaF french scale 1F≈0.33mm,腦血管造影的順序,第一步，主動脈弓造影。豬尾導(dǎo)管頭置于主動脈弓起始部，管球左前30-45度角。第二步，右側(cè)頸動脈造影。先行右側(cè)頸總動脈造影，此

55、時需看側(cè)位，導(dǎo)管頭置于頸4椎體下緣。頸總動脈看完后，把導(dǎo)管送入頸內(nèi)動脈，正側(cè)位都要把顱骨內(nèi)板內(nèi)側(cè)的腦組織包全，正位還要把管球向頭側(cè)傾斜,即湯氏位（Townes projection）。第三步，左側(cè)頸動脈造影。順序基本同第二步。第四步，左側(cè)椎動脈造影。正位也要把管球向頭側(cè)傾斜30度。側(cè)位要把外耳道放在顯示器的中心。第五步，右側(cè)椎動脈造影。,腦血管造影常用位置,1.主動脈弓：左前斜約30～40°。2.頸動脈：正位和斜位，左

56、側(cè)頸動脈加左前斜，右 側(cè)加右前斜，度數(shù)約45～60°。3.頸內(nèi)動脈顱內(nèi)段：正湯氏位＋側(cè)位。4.大腦中東脈：正湯加對側(cè)斜，如左側(cè)大腦中動脈為正湯＋右側(cè)斜約30～40°。5.大腦前動脈：正湯加同側(cè)斜，如左側(cè)大腦前動脈為正湯＋左側(cè)斜約30～40°。6.椎動脈：正湯加同側(cè)斜，如左側(cè)大腦后動脈為正湯＋左側(cè)斜約30～40°，必要時加返湯。,肝素化,用肝素化方法較安全,初始量按體重（Kg）2/3

57、計算（mg），或70-100u/Kg,一小時后追加初始量的一半。若病人術(shù)前接受低分子肝素治療，肝素用量減半。術(shù)后魚精蛋白中和,魚精蛋白:肝素1~1.5:1 普通肝素劑型：每支12500u/100mg,常用材料費用,,,OTW (over the wire) 經(jīng)導(dǎo)絲傳送系統(tǒng)：球囊導(dǎo)管或支架的全長均在導(dǎo)絲上，需要用256cm超長導(dǎo)絲，在助手協(xié)助下完成操作。RX (rapid exchang) 快速交換系統(tǒng)：球囊導(dǎo)管或支架