【ppt】-冠状动脉介入治疗球囊的选择.ppt

冠状动脉介入治疗球囊的选择,徐州中心医院 吴强,球囊分类,整体交换球囊（OTW- over the wire) 快速交换球囊 (monorail),球囊的结构,球囊尖端 球囊 推送杆,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,,,,,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开辟新纪元的零折叠技术,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,,,Sprinter 1.5mm,Sprinter Legend 1.25&1.5mm,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,,球囊性能,外径（crossing profile) 灵活性（flexibility) 跟踪性（trackbility) 推送性（pushbility) 顺应性（compliance),球囊操作要领,,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,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）血管内超声（IVUS）: 血管钙化,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,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、降低分支闭塞的概率常用的球囊特点,,Maverick® PTCA Balloon Catheters,Proprietary 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 enhanced crossability.,Apex™ PTCA Dilatation Catheter,Slope™ 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 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 andpushability to the outer shaft,Quantum™ Maverick® Balloon,Low profile, 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*,NC sprinter,外形细小的FasTrac头端技术-可在遇到较难通过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。

Sunflex Tip is superbly engineered to give a perfect balance between flexibility and kink resistance. ‘Zero’ transition between the tip and wire for smoothestentry profile. Tapered Tip:The tapered soft tip combined with advanced laser welding technology provides the most competitive tip profile Slidematrix dual coating is specially formulated withtwo unique proprietary blends. Hydrophilic and Invio coatings 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 slenderprimary profile for enhanced crossabilitythrough tight lesions. Sapphire NC,OrbusNeich,,The 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 smoothlesion entry and minimal vessel trauma. The Invio coating on the inner lumen eliminates friction between the catheterand guidewire. Invio is also applied to the outer distal segment from the tipto the exit marker zone for lubricious crossability. Avita HP,OrbusNeich,Rugin,CrossTipTM 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 CrossTipTM 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Hypotube 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Voyager,Superb Cross Tapered Tip Design New 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 tough lesions Flexible tungsten marker technology allows catheter to conform to tortuous anatomy More Options — Low Profile Shaft Design Versatile treatment in a 6F guide Excellent track and push in tortuous anatomy with new hypotube design Reinforced mid-shaft design provides flexibility and additional support Flexibility with Visibility — Proprietary Tungsten Marker New 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 Dilatation — Proven Balloon Performance Short tapers allow for precise dilatation Improved LOFOLD Balloon Technology processes allows for excellent rewrap and recross1 XCELON S Balloon Material achieves superb flexibility,。