中国慢性完全闭塞介入治疗2016新进展 - fumed · 中国慢性完全闭塞介入治疗...

中国慢性完全闭塞介入治疗2016新进展

葛均波

复旦大学附属中山医院上海市心血管病研究所

中国慢性完全闭塞介入治疗

2016新进展

1.新型导引钢丝的应用

2.新型器械的应用

3.ADR技术的应用

4.逆向技术更加规范化

Fielder XT-R

Fielder XT-A

Gaia First

Gaia Second

Gaia Third

Fielder XT-A和Fielder XT-R的临床应用

CrossabilityOccluded lesions

without a stump.

TrackabilityCollateral channel

tracking.

Sub total occlusion


2016新进展

Gaia 基本结构Total Length 1900mm

SLIP-COAT® Coating Length 400mm

Coil Length 150mm0.36mm

(0.014inch) PTFE coat

对应手术中不同情况和不同病变的各种型号

Diameter ：0.26mm (0.010”) - 0.36mm (0.014”)

Tip load ：1.7gf

Diameter ：0.28mm (0.011”) - 0.36mm (0.014”)

Tip load ：3.5gf

Diameter ：0.30mm (0.012”) - 0.36mm (0.014”)

Tip load ：4.5gf

ASAHI Gaia First

ASAHI Gaia Second

ASAHI Gaia Third

涂有亲水性涂层处理，微导管内输送导丝时更加轻松顺滑


2016新进展

传统的导丝头端

ASAHI Gaia micro-cone 头端

微锥形头端设计提高了导引钢丝的穿透力，使导丝容易进入闭塞病变

Gaia 头端设计：Micro-cone


2016新进展

1.7gf3.5gf

12gf

5.0gf4.5gf

12gf

12gf

9.0gf头端直径

kg/inch2

头端设计与穿透力


2016新进展

1.7gf

3.5gf

4.5gf

12gf

5.0gf

12gf

12gf

9.0gf

kg/inch2

ASAHI Gaia micro-cone 头端直径

微锥形头端设计与穿透力


2016新进展


2016新进展





KANEKA Dual Lumen (Crusade)

Guidezillar

Kaneka Dual Lumen catheter (KDL)

KDL parallel wiring

KDL reverse wiring

KDL in CTO with acute angle

KDL in CTO with bifurcation


2016新进展

049103

KDL parallel wiring


2016新进展

049103

6F AL 0.75 KDL Parallel wiring with M3 and Conquest Pro


2016新进展

049103

KDL Parallel wiring with M3 and Crosswire NT


2016新进展

049103

Final Result


2016新进展

56698

KDL in CTO with acute angle


2016新进展

56698

KDL+ Fielder XT, M3


2016新进展

56698

Final Result


2016新进展

KDL in CTO with bifurcation


2016新进展

Corsair + Fielder XT-R


2016新进展

Retrograde Crossing with Fielder XT


2016新进展

KDL with Sion to RCA-PDA


2016新进展

Final Result


2016新进展

GuidezillaTM结构概述

A. 120 cm 近端海波管

C. 内嵌式聚合物包裹

B. 0.057” (1.45 mm) 内径

E. 1:1钢丝编织层

F. 25cm 导引导管段

G. 亲水涂层

I. 无创头端

D. 近端标记带

A

B

D

IG

F

C

E

H. 远端标记带

H


2016新进展


2016新进展

Guidezilla在CTO-PCI中的应用

1. 当球囊/支架无法通过闭塞病变时

2. Guidezilla Reverse CART技术

056253

当球囊/支架无法通过闭塞病变时


2016新进展

056253

7F AL 0.75 SH


2016新进展

056253

Reverse CART attempted, but balloon not cross proximal lesion


2016新进展

056253

Kissing wire with Crosswire NT


2016新进展

056253

Guidezilla with Balloon Anchoring Technique


2016新进展

CTO病变介入治疗新器械临

床应用

056253

Predilatation and Stenting with Guidezilla

Stenting with Guidezilla

056253


2016新进展

Final Result

056253


2016新进展

61338

Male, 66 yrs

J-CTO Score 4: Without stump, calcification, length >20mm, re-try (*2) case

Guidezilla Reverse CART


2016新进展

61338

Sion , Fielder XT-R


2016新进展

61338

Reverse CART: Fielder XT+ 2.5mm,3 mm balloon

2.0mm balloon anchoring technique


2016新进展

61338

Guidezilla

2.5mm balloon

GAIA First

Reverse CART: GAIA First + 2.5mm balloon+ Guidezilla


2016新进展

61338

Reverse CART: GAIA First + 2.5mm balloon+ Guidezilla


2016新进展

Prox

Dist


2016新进展

61338

Final results


2016新进展


2016新进展




4.逆向技术更加规范化CrossBoss, Stingray

Crossboss

• Crossboss

– Highly torqueable coil wired shaft

– Atraumatic tip rarely exits vessel

– True lumen or adventitial CTO crossing


2016新进展

61887

Male, 60 yrs

CrossBoss in ISR-CTO


2016新进展

61887

7F EBU 3.5 SH6F SAL 1.0 SH


2016新进展

61887

CrossBoss, Fielder XT, Ultimatebros 3


2016新进展

61887

CrossBoss, Fielder XT


2016新进展

61887

Final results


2016新进展

Stingray

Access the distal vessel with

the Stingray wire (strike

across) withdraw and remove.

The Stingray balloon remains

aligned with the channel

created from false to true

lumen.


2016新进展


2016新进展

Antegrade attempt with GAIA 2


2016新进展

Failure of Retrograde Attempt with XT-R


2016新进展

Antegrade Knuckle Wiring with Pilot 150


2016新进展

Antegrade Dissection –

Set up for Re-Entry

After MB12 advanced through

the CrossBoss and the

CrossBoss is withdrawn.

Stingray catheter is advanced

over a Miracle 12 wire to the

re-entry position.


2016新进展


Stingray® Re-Entry

A Stingray® guidewire is

advanced out the lumen facing

port and advanced until the wire

crosses the angiographic

lumen.

The angle between the catheter

and the wire suggests that the

wire has engaged tissue and

has likely re-entered the vessel.


2016新进展


Stingray Re-Entry


2016新进展

Final Result


2016新进展


2016新进展





与既往过多尝试Kissing wire technique、

retrograde wire crossing 技术不同，目前有

经验的术者只在病变较短时（<20mm）,尝

试逆向导引钢丝通过技术或对吻技术，更多

的时候则是使用Reverse CART技术和

Contemporary Reverse CART技术。


2016新进展

中国慢性完全闭塞介入治疗2016新进展 - fumed · 中国慢性完全闭塞介入治疗...

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