冠脉介入治疗导引导丝的选择及操作基础PDF版另有word版

冠脉导引导丝——选择和操控基础Guide Wire Strategy CEU 选择导引导丝的策略Criteria for Guide Wire Selection选择导丝的标准Within Operator’s Control 术者可控因素•Operator preference/experience 术者的偏爱/经验•Device selection 选择哪些器械Not Within Operator’s Control 术者不可控因素•Vessel anatomy 血管解剖走行•Lesion location/morphology 病变位置/形态Frontline 常见病变Tortuous迂曲血管病变Extra Support需超强支撑的病变Chronic Occlusions慢性闭塞病变Determining guide wire selection for specific clinical challenges 根据临床病变特征选择导丝绝大多Majority of procedures, straightforwardand complex cases 数手术的首选，简单和复杂病例都包括GW Performance Characteristics 导丝的性能•Often select favorite wire 通常选最喜欢的导丝•Flexibility and steering 柔软、操控性好•Soft tip 头端柔软•Support for device delivery 为输送器械提供足够支撑力Clinical Challenge 临床需求Workhorse/Frontline cases 常见病变Frontline Guide Wire Case常见病变选择一线导丝•Majority of cases begin with “Frontline” wire with familiar response, to learn about anatomy 绝大多数病例都是从“一线”导丝开始，以便了解 病变和血管解剖特点•A frontline guide wire case can be routine or complex 一线导丝既可用于简单病变，也可用于复杂病变Normal ?Acute Complex临床治疗需求不同——不同功能的导丝应运而生进入及通过高度狭窄病变迂曲病变，工作导丝 无法满足治疗需要常规A 型和B 型病变升级导丝工作导丝Abbott ：BMW BMW ELITE VersaTurn Terumo ：Asahi ： Rinato Sion/Sion Blue 超滑导丝Abbott ： Pilot 50 Whisper Asahi ：Fielder FCRunthrough extre Floppy Fielder XT XTR Sion black Boston PT2强支撑导丝Abbott ： BHW CTO 导丝Abbott ：Pilot 150，200Progress Asahi ：Fielder XTFielder XT-A/R MIRACLECONQUEST PRO GAIA Terumo:Crosswire NTGW Performance Characteristics 导丝的性能•Requires exceptional steeringand tracking capabilities, without prolapse 杰出的扭 控性和跟踪性，头端无脱垂•Tip control 头端的操控性•Long or transitionless core tapers for improved wire tracking 长或流线型椎体，以提高跟踪性导丝不Challenging access cases, oftenwith acute vessel take-offs易到达病变，通常侧支血管呈锐角发出Clinical Challenge 临床需求Tortuous anatomy cases 迂曲血管病变Guide Wire Strategy 选择导丝的策略迂曲血管病变导丝: 覆有聚合物护套… 专为迂曲的血管而设计迂曲血管成角病变改良的RESPONSEASE 流线形核芯锥体在优化扭控性的同时提供额外的支撑力1HI-TORQUE PILOT 501 As configured to the ChoICE ® and PT Graphix™ INT.Test performed by and data on file at Abbott Vascular.单个标记聚合物护套和亲水涂层使导丝轻松通过病变头端弹簧圈使导丝的头端柔 软、易塑形，并提供良好的触觉反馈临床治疗需求不同——不同功能的导丝应运而生进入及通过高度狭窄病变迂曲病变，工作导丝 无法满足治疗需要常规A 型和B 型病变升级导丝工作导丝Abbott ：BMW BMW ELITE VersaTurn Terumo ：Asahi ： Rinato Sion/Sion Blue 超滑导丝Abbott ： Pilot 50 Whisper Asahi ：Fielder FCRunthrough extre Floppy Fielder XT XTR Sion black Boston PT2强支撑导丝Abbott ： BHW CTO 导丝Abbott ：Pilot 150，200Progress Asahi ：Fielder XTFielder XT-A/R MIRACLECONQUEST PRO GAIA Terumo:Crosswire NT提供高•Higher level of support forstraightening vessel and assisting with device delivery强度支撑力以拉直血管，协助输送器械器械或Extra Support cases 需超强支撑病变Device or anatomy requiresadditional guide wire support血管需要导丝提供额外的支撑GW Performance Characteristics 导丝的性能Clinical Challenge 临床需求Guide Wire Strategy 选择导丝的策略Extra Support Cases 需超强支撑的病变Vessel take-off / Bifurcation 分支呈锐角发出 / 分叉病变Tortuosity 血管迂曲HT BALANCE HEAVYWEIGHTBHW支撑力较BMW增强一倍,适当拉直迂曲血管,便于输送器械BHW导丝的头端柔软,安全且易于塑形,头端硬度与BMW相似Balance Middleweight™ (BMW)Balance Heavyweight™ (BHW)临床治疗需求不同——不同功能的导丝应运而生进入及通过高度狭窄病变迂曲病变，工作导丝 无法满足治疗需要常规A 型和B 型病变升级导丝工作导丝Abbott ：BMW BMW ELITE VersaTurn Terumo ：Asahi ： Rinato Sion/Sion Blue 超滑导丝Abbott ： Pilot 50 Whisper Asahi ：Fielder FCRunthrough extre Floppy Fielder XT XTR Sion black Boston PT2强支撑导丝Abbott ： BHW CTO 导丝Abbott ：Pilot 150，200Progress Asahi ：Fielder XTFielder XT-A/R MIRACLECONQUEST PRO GAIA Terumo:Crosswire NTClinical Challenge 临床需求Chronic Stenosed Lesion Cases 慢性闭塞病变Cross Stenosed Lesions while minimizing vessel trauma 通过闭塞病变的同时，尽量减少血管损伤的可能GW Performance Characteristics 导丝的性能•Tip Control, including in-lesion 头端操控性，包括在闭塞病变中 走行时•Variable tip stiffness 不同的头端硬度•Tapered tip 锥形头端•Torqueability and steerability 扭控性和操控性•Tactile feedback 触觉反馈•OTW balloon for exchanges 可与OTW 球囊共用Guide Wire Strategy 选择导丝的策略Chronic Stenosed Lesions Strategy Options 慢性闭塞病变的导丝选择策略手术难度ØWhichever option is chosen, remember 无论如何选择，谨记：•Persistence 百折不挠•Multiple views of wire andØdistal target 多角度观察导丝和远端靶病变•Frequent wire exchanges may be necessary and will increase the complexity Øof case 常需多次交换导丝， 可能会增加HI-TORQUE CROSS-IT 100, 200, 300 & 400亲水涂层提高导丝远段的跟踪性Core-to-tip头端提供良好的触觉反馈，易于在病变内操控导丝带有弹簧圈护套的头端，从末端3cm开始其外径从 .014” 至.010”呈锥形变细，使导丝易于穿过困难病变领先的锥形头端技术, 尖端的外径仅为 0.010”，易于穿过慢性闭塞病变临床治疗需求不同——不同功能的导丝应运而生进入及通过高度狭窄病变迂曲病变，工作导丝 无法满足治疗需要常规A 型和B 型病变升级导丝工作导丝Abbott ：BMW BMW ELITE VersaTurn Terumo ：Asahi ： Rinato Sion/Sion Blue 超滑导丝Abbott ： Pilot 50 Whisper Asahi ：Fielder FCRunthrough extre Floppy Fielder XT XTR Sion black Boston PT2强支撑导丝Abbott ： BHW CTO 导丝Abbott ：Pilot 150，200Progress Asahi ：Fielder XTFielder XT-A/R MIRACLECONQUEST PRO GAIA Terumo:Crosswire NTGuide Wire Manipulation Guidelines操作导丝的指导方针Optimizing Guide Wire Performance操控导丝的技巧•Maintain free movement of wire tip 保持导丝头端活动自如•Withdraw or reposition if needed 必要时回撤或重新放置•Avoid undue force 避免过度用力•Avoid excessive rotation 避免过度旋转•Do not lose your wire position…however 确保导丝处于正确位置•If wire position is lost, use caution when recrossing a dilated lesion and confirm luminal position 如果导丝偏离了正确位置，在重新放置导丝通过已扩张病变时应小心操作，并确认导丝始终位于血管真腔内Guide Wire Manipulation Guidelines操作导丝的指导方针Steering and tactile feedback 操控性和触觉反馈•Typical steering techniques include small alternating rotations from left to right, or larger clockwise rotations操控手法包括左、右方向来回轻微旋转，或顺时 针转动•Free wire tip motion is important to avoid catching plaque or dissection 头端保持活动自如，意味着导丝没有碰到斑块或进入夹层•Physicians rely on tactile feedback to learn about the vessel anatomy andcontrolsteering the wire医生根据触觉反馈来判断血管的解剖走行，并操控导丝•A guide wire torque device is used tofacilitate steering 导丝扭转器有助于对导丝的操控肝素盐水冲洗激活导丝亲水涂层取出冠脉导丝Guide Wire Shaping 导丝的塑形擦拭导丝注意操控导丝单人操作送球囊撤出球囊或支架输送支架或球囊注意THANKS !。