睹彬椎動(dòng)脈支架植入術(shù)課件

椎動(dòng)脈支架的植入技巧首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院急診介入科杜彬1精選版課件ppt椎動(dòng)脈支架的植入技巧首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院1精選版課件引言與后循環(huán)卒中相關(guān)的死亡率在20~30%，遠(yuǎn)高于前循環(huán)梗死的死亡率后循環(huán)的動(dòng)脈粥樣硬化性狹窄，常見部位是椎動(dòng)脈開口椎動(dòng)脈開口的支架成形治療是安全、可行的CrawleyF,BrownMM.CochraneDatabaseSystRev2:CD000516,2000.HigashidaRT,TsaiFY,HalbachVV,etal.JNeurosurg78:192–198,1993.MoufarrijNA,LittleJR,FurlanAJ,etal.Stroke15:260–263,1984.Rocha-SinghK:Vertebralarterystenting.CatheterCardiovascInterv54:6–7,2001.SpetzlerRF,HadleyMN,MartinNA,etal.JNeurosurg66:648–661,1987.2精選版課件ppt引言與后循環(huán)卒中相關(guān)的死亡率在20~30%，遠(yuǎn)高引言任何技術(shù)的使用，首先要服從于安全技術(shù)的應(yīng)用與下列因素有關(guān)與操作者的經(jīng)驗(yàn)常用的器材對(duì)器材的了解3精選版課件ppt引言任何技術(shù)的使用，首先要服從于安全3精選版課件大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入4精選版課件ppt大綱投照體位4精選版課件ppt大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入5精選版課件ppt大綱投照體位5精選版課件ppt投照體位關(guān)鍵點(diǎn)切線位6精選版課件ppt投照體位關(guān)鍵點(diǎn)6精選版課件ppt投照體位關(guān)鍵點(diǎn)弓上起源左前斜位7精選版課件ppt投照體位關(guān)鍵點(diǎn)7精選版課件ppt大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入8精選版課件ppt大綱投照體位8精選版課件ppt入路的選擇手術(shù)入路的選擇上肢入路右椎開口低血管開口的角度橈動(dòng)脈肱動(dòng)脈股動(dòng)脈入路Allentest9精選版課件ppt入路的選擇手術(shù)入路的選擇Allentest9精選版課件p入路的選擇橈動(dòng)脈入路ApositiveAllentestWhenthereisadequatecollateralcirculationtothehandfromtheulnararteryandapalmarblushoccurswithin5–10secondsafterreleasingtheulnararteryAbeS,MeguroT,EndohN,etal.CatheterCardiovascInterv.2000;49:253–56Punctureisbestperformedapproximately2–3cmcephaladtotheradialstyloidMostpatientscantolerateuptoa6FsheathwithoutundueriskofradialarteryinjuryAftersheathplacement,antispasmprophylaxisisperformed3mgofverapamilintotheradialarterysheathLaytonKF,Kallmes

DF,Cloft

HJ.AJNRAmJNeuroradiol.2006;27:1151–5410精選版課件ppt入路的選擇橈動(dòng)脈入路AbeS,MeguroT,End大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入11精選版課件ppt大綱投照體位11精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)引導(dǎo)管的放置關(guān)鍵點(diǎn)接近病變穩(wěn)定性避開鎖骨下動(dòng)脈的斑塊12精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)引導(dǎo)管的放置關(guān)鍵點(diǎn)12精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置主動(dòng)脈弓分型ArchtypeAArchtypeBArchtypeC13精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置主動(dòng)脈弓分型13精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置主動(dòng)脈弓分型A型B型C型14精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置主動(dòng)脈弓分型A型B型C型14精選版課件p導(dǎo)引導(dǎo)管和導(dǎo)絲的放置加強(qiáng)穩(wěn)定性“Buddy”wire6F/8F導(dǎo)引導(dǎo)管+0.035或0.018導(dǎo)絲15精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置加強(qiáng)穩(wěn)定性15精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)絲的放置的關(guān)鍵點(diǎn)導(dǎo)絲頭端的塑形16精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)絲的放置的關(guān)鍵點(diǎn)16精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)絲的放置的關(guān)鍵點(diǎn)遠(yuǎn)端血管情況導(dǎo)絲的放置頭端位于顱外足夠的支撐力逐漸增加硬導(dǎo)絲放置采用交換技術(shù)17精選版課件ppt導(dǎo)引導(dǎo)管和導(dǎo)絲的放置導(dǎo)絲的放置的關(guān)鍵點(diǎn)17精選版課件ppt大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入18精選版課件ppt大綱投照體位18精選版課件ppt保護(hù)裝置的放置和回收使用保護(hù)裝置的指征椎動(dòng)脈直徑>3.5mm椎動(dòng)脈開口的角度合適潰瘍病變遠(yuǎn)端血管不能過度迂曲WehmanJCH,HanelRA,GuidotCHA,etal.JIntervenCardiol.2004;17:219-232.

19精選版課件ppt保護(hù)裝置的放置和回收使用保護(hù)裝置的指征WehmanJCH,保護(hù)裝置的放置和回收20精選版課件ppt保護(hù)裝置的放置和回收20精選版課件ppt保護(hù)裝置的放置和回收4FcatheterrecerveprotectiondeviseQureshiAI,KirmaniJF,Harris-LanePetal.AJNR27May200621精選版課件ppt保護(hù)裝置的放置和回收4Fcatheterrecerve大綱投照體位入路的選擇導(dǎo)引導(dǎo)管和導(dǎo)絲的放置保護(hù)裝置的放置和回收支架的置入22精選版課件ppt大綱投照體位22精選版課件ppt支架的置入椎動(dòng)脈開口支架置入關(guān)鍵點(diǎn)支架的選擇支架的類型直徑長(zhǎng)度支架置入定位球囊充盈速度、次數(shù)Watermelonseeding23精選版課件ppt支架的置入椎動(dòng)脈開口支架置入關(guān)鍵點(diǎn)23精選版課件ppt支架的置入支架的選擇支架的類型球囊擴(kuò)張支架自膨支架直徑長(zhǎng)度24精選版課件ppt支架的置入支架的選擇24精選版課件ppt支架的置入支架置入定位完全覆蓋病變遠(yuǎn)斷3-5mm近端2-3mm WehmanJCH,HanelRA,GuidotCHA,etal.JIntervenCardiol.2004;17:219-232.

25精選版課件ppt支架的置入支架置入WehmanJCH,HanelRA,支架的置入支架置入定位完全覆蓋病變遠(yuǎn)斷3-5mm近端2-3mm 26精選版課件ppt支架的置入支架置入26精選版課件ppt支架的置入支架置入球囊充盈速度、次數(shù)Watermelonseeding27精選版課件ppt支架的置入支架置入27精選版課件ppt支架置入Watermelonseeding28精選版課件ppt支架置入Watermelonseeding28精選版課件p支架置入Watermelonseeding29精選版課件ppt支架置入Watermelonseeding29精選版課件p支架置入WatermelonseedingFirststent2ndStent

30精選版課件ppt支架置入WatermelonseedingFirstst椎動(dòng)脈支架的植入技巧操作過程中注意可視范圍路徑圖操作過程中平靜呼吸31精選版課件ppt椎動(dòng)脈支架的植入技巧操作過程中注意31精選版課件ppt32精選版課件ppt32精選版課件pptAlesscommontypeofVAdiseaseinvolvesmultipletandemlesionswithtortuosityandangulation.ThestiffPalmazstentisill-equippedforthis.Finally,forlesionsintheV2segment,wherethevesselpassesthroughtheVAcanal,theordinaryvesseloverstretchmechanismofPTAisinefficientbecauseofthebonesurroundingthevessel.Here,wefirstusedflexibleballoon-expandablestents(thatis,Multilink,GFX),butquicklyswitchedtotheself-expandabletype(RadiusorMagicWallstent)becauseofthetheoreticalriskofstentc