介入中球囊和支架的应用

冠状动脉介入治疗的球囊和支架的应用中国医学科学院阜外心血管病医院高展冠状动脉介入治疗球囊的选择球囊分类整体交换球囊（OTW-overthewire)快速交换球囊(monorail)RapidExchangeGuidewireInflationlumen&guidewirelumenInflationlumenonlyInflationportOver-the-WireGuidewireInflationlumen&guidewirelumenInflationPort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折叠方式：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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性能外径（crossingprofile)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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（1.5mm）球囊，如Maverick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。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。常用的球囊特点Maverick®PTCABalloonCathetersProprietarylaserbondedtechnologycreatesanextraordinaryTrakTip™Designandprecise,smoothbondsthroughouttheshaft.Pushcoildesignandimproveddistalflexibilityforenhancedtrackability.Our1.5and2.0mmSoftLEAP™Balloonsofferenhancedcrossability.Apex™PTCADilatationCatheterSlope™OuterShaftsmoothlytransitionsfromstifftoflexible,allinonepiece,formoreefficientpushtransmissionBi-Segment™InnerShaftoptimizesthebalancebetweenpushandtrackShorter,thinnermarkerbandsincreasedistalflexibilityRedesignedtipwithimprovedflexibilityandwiremovement;sameultra-low0.017profileOptiLEAP™BalloonwithreducedwaistthicknessprovidesgreatsizingflexibilitywithlowerprofilesNano-compositematerialsaddsstructureandpushabilitytotheoutershaftQuantum™Maverick®BalloonLowprofile,fulllength1.8For2.0FMonorail™shaftLowprofile3.2Fproximalover-the-wireshaftBioslide™CoatingonaPEBAX®DistalShaftLaserbondingtechnologyQuantumLEAPBalloonMaterialTaperedTrakTip™Designwith.017lesionentryprofile*Quantum™Maverick®BalloonNCsprinter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FulcrumPlus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。SunflexTipissuperblyengineeredtogiveaperfectbalancebetweenflexibilityandkinkresistance.‘Zero’transitionbetweenthetipandwireforsmoothestentryprofile.TaperedTip:ThetaperedsofttipcombinedwithadvancedlaserweldingtechnologyprovidesthemostcompetitivetipprofileSlidematrixdualcoatingisspeciallyformulatedwithtwouniqueproprietaryblends.HydrophilicandInviocoatingsareappliedtothedistalleadingtipsectionandtheballoon/shaftsection,respectivelytoprovideanoptimalbalancebetweenlubriciouscrossingandminimizingwatermelonseedingTightFoldprocessingresultsinaslenderprimaryprofileforenhancedcrossabilitythroughtightlesions.SapphireNCOrbusNeichTheIPTransitionZoneoftheAvitaPTCADilatationCatheterprovidesintensifiedpushability.Thenewtaperedtipdesignwithsoftmaterialexhibitsaflexibletipforsmoothlesionentryandminimalvesseltrauma.TheInviocoatingontheinnerlumeneliminatesfrictionbetweenthecatheterandguidewire.Invioisalsoappliedtotheouterdistalsegmentfromthetiptotheexitmarkerzoneforlubriciouscrossability.AvitaHPOrbusNeichRugin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RyuginCrossTip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(FlexibleCorrugate)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SuperbCrossTaperedTipDesign1.Newtaperedtipwith.017”tipentryprofiledesignedtocrosstightlesions2.Improvedtip-to-wireconformability1forconfidenttrackandcross3.Polyurethanetipmaterialisflexibleyetdurablefortoughlesions4.FlexibletungstenmarkertechnologyallowscathetertoconformtotortuousanatomyMoreOptions—LowProfileShaftDesign1.Versatiletreatmentina6Fguide2.Excellenttrackandpushintortuousanatomywithnewhypotubedesign3.Reinforcedmid-shaftdesignprovidesflexibilityandadditionalsupportFlexibilitywithVisibility—ProprietaryTungstenMarker1.Newmarkermaterialcomprisedoftungstenpolymer2.Flexiblemarkerdesignallowsthecathetertoconformmoreeasilytotortuousanatomy3.IncreasedmarkerflexibilityhelpstoreduceresistancewhencrossingtightlesionsPreciseDilatation—ProvenBalloonPerformance1.Shorttapersallowforprecisedilatation2.ImprovedLOFOLDBalloonTechnologyprocessesallowsforexcellentrewrapandrecross13.XCELONSBalloonMaterialachievessuperbflexibilityPowersailPLATEAUBalloonMaterial1.Providesnon-complianceathighpressurewithoutcompromisingperformance2.FlexibilityandconformabilityforexcellentdeliverabilityLOFOLDBalloonTechnology1.Providesalowcrossingprofileforexceptionallesioncross2.LOFOLDballoontechnologyforimprovedballoon