CTO导丝优秀课件.ppt

CTO导丝的的选择中山大学附属第一医院杜志民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30-50% CTO with Micro-channels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钻行技术穿行技术滑行技术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Polymer cover with Hydrophilic CoatingHydrophilic CoatingHydrophobic CoatingNo Coating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几种滑导丝Fielder FC& Fielder XT0.009”0.009”Fielder XTFielder XTFielder FCFielder FC11cm Spring Coil11cm Spring Coil3cm Radio-opaque Coil0.014”0.014”20cm Polymer Sleeve & SLIP COAT®20cm Polymer Sleeve & SLIP COAT®PTFE CoatingPTFE CoatingStainless Steel CoreStainless Steel Core16cm Radio-opaque spring coil16cm Radio-opaque spring coil16cm Polymer Sleeve & SLIP COAT®16cm Polymer Sleeve & SLIP COAT®0.014”0.014”PTFE CoatingPTFE CoatingStainless Steel CoreStainless Steel CoreFielder FC11cm 弹簧圈段3cm 显影段0.014”20cm 聚合物及亲水涂层PTFE 涂层不锈钢核心Fielder X-treme16cm 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PTFE coatingRope coil & Radiopaque segment 3cmSLIP COAT® Hydrophilic coating 21cmSpring coil 18cmStainless steel high-tension core0.014”TIP LOAD:0.5G3300mm 80mm1600mm（硅油涂层）φ0.26mm (0.010”)φ0.26mm (0.010”)30mm：Pt 50mm：SUS1700mm（亲水涂层 ）•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Product InformationCore Technologies in Wire DesignDrawingTorque+Wire FormingTorque+CoatingCoreCoilGuide Wire33Structure・Radiopaque　length：3cm・Coating　length：28cm（Full coating）・Tip load ：0.7gJoint-less spring coilComposite　Core34ACT ONECoilTwist coreCore wireComposite　　CoreSix wire ropeHollow tube35CoilCore wireComposite　　CoreTwist core36Composite　　CoreThe Composite Core Improves Torque and Tip Shape Retention1．Tip breakage　＝　Kink in Core wire→　ACT ONE protects the Core wire2．Prevents Torque “Whip”　→　Prevents whip by stopping torque build-up　37Composite　　CoreACT ONE benefits1．Shape protection2．Torque transmissionTwist core benefits1．Stronger tip→　Composite Core allows for a smaller diameter core wire2．Negates “whipping”38几种硬几种硬导丝HI-TORQUE PROGRESS: 新一代慢性闭塞病变导丝新一代慢性闭塞病变导丝Asahi MiracleBros 3不锈钢聚合物护套/混合涂层穿透力穿透力高性能高性能标准标准穿透力低穿透力低穿透力高穿透力高Tests performed by and data on file at Abbott VascularAsahi MiracleBros 12CROSS-IT 200XT | 300XTCROSS-IT 100XTAsahi MiracleBros 4.5 CROSS-IT 400XTAsahi Confianza Pro 9 | 12Asahi Fielder XT HT PROGRESS 40HT PILOT 50 | 150 | 200 HT PROGRESS 80HT PROGRESS 120HT PROGRESS 140THT PROGRESS 200THI-TORQUE PROGRESS Guide Wire In-Service for OUSLT2929781 Rev G© 2010 Abbott Laboratories. Information contained herein for distribution outside of the US & Japan only3 cm radiopaque coil29.5 cm polymer sleeveTests performed and data on file at Abbott VascularSMOOTHGLIDE: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端直径:0.012” (40, 80, 120)0.0105” (140T, 锥形)0.009” (200T,锥形)中段聚合物中段聚合物护套覆盖套覆盖亲水水涂涂层 : 使导丝在病变中具有最大的可操控性CORE-TO-TIP DURASTEEL: 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端弹簧圈簧圈: 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引领慢性闭塞病变导丝技术: HI-TORQUE PROGRESS 系列导丝HI-TORQUE PROGRESS Guide Wire In-Service for OUSLT2929781 Rev G© 2010 Abbott Laboratories. Information contained herein for distribution outside of the US & Japan onlyHI-TORQUE PROGRESS 系列导丝系列导丝￿ ￿HI-TORQUE PROGRESS 40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-TORQUE PROGRESS 80头端设计便于滑行或钻行HI-TORQUE PROGRESS 120提供更硬的头端以便钻行HI-TORQUE PROGRESS 140T锥形头端 (0.0105”) 便于穿刺慢性闭塞病变HI-TORQUE PROGRESS 200T具有 0.009” 直径的头端 以便穿刺慢性闭塞HI-TORQUE PROGRESS Guide Wire In-Service for OUSLT2929781 Rev G© 2010 Abbott Laboratories. Information contained herein for distribution outside of the US & Japan onlyHI-TORQUE Progress 设计优点设计优点￿￿￿￿穿透力采用穿透力便于慢性闭塞导丝的直接比较Tests performed by and data on file at Abbott VascularKg/inch²HI-TORQUE PROGRESS Guide Wire In-Service for OUSLT2929781 Rev G© 2010 Abbott Laboratories. Information contained herein for distribution outside of the US & Japan only导丝的选择•Always start with–the soft wires •Quickly upgrade –to stiffer wires–in a step up strategyAs 30-50% CTO with Micro-channelsAs micro-channels are sometimes not visible导丝的选择Which wire and when？Micro-channel visible：Plastic jacket or hydrophilic wire–Filelder XT, Filelder FC & Fleider–Pilot 50–Runthrough NSSevere fibro calcific segment ：Stiff extra support wires –Miracle series 3,4.5,6,12 gm–Cross IT 100,200,,300,400–Intermediate wires–Conquest pro, 9/12 gm。