慢性完全性闭塞的导丝技术介绍

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1、IntroductionwiretechniquesofchronictotalocclusionsJunDai,M.D.CoronarydiseasecenterFuwaiHospitalCAMS&PUMCBeijingContentsDefinitionPathologyAngiographyimagingPCItechnicalchallengeguidewiretechnologyinterventionaldevicesrevascularizationtechnologyDefini

2、tionofCTOChronictotalocclusionsaredefinedasocclusionsgreaterthan3(1)montholdwithangiographicTIMI0orTIMI1flowTheSpectrumofLumenMorphologyinCTO:ClinicalChallengesNecroticcoreProteoglycan-richCalcificationLargerecanalizationchannelsInflammationSmallreca

3、nalizationchannelsFibroticplq:NegativeremodellingChronicTotalOcclusionsWhat’sBlockinguptheLumen?1.DenseFibroticTissue:COLLAGEN!2.CalcificationNCVIntraluminalCollagenExtracellularMatrix:Collagen,CalciumIncreasedfibrocalcificplaqueswithageSrivatsaetal

4、,JAmCollCardiol1997:29:955-63IntraluminalCalcificationVariablesrelatedsuccessAgeofOcclusionEntryLengthTortuousityCalciumCollateralsDistalVesselSizeIn-stentocclusiondevicesAnatomicDescriptorsofProceduralSuccessAnatomyofaCTOGuidewireGuidewireOperatorT

5、echniquesSimplified“Lesion-Specific”CTOGuidewireUseAlgorithmsCTOGuidewireDesignCTOGuidewireCategoriesAnatomyofaCTOGuidewireGuidewireOperatorTechniquesSimplified“Lesion-Specific”CTOGuidewireUseAlgorithmsCTOGuidewireDesignCTOGuidewireCategoriesHallmark

6、sofaCTOGuidewireTipstyles-core-to-tipdesigns;sometimestaperedCoilsandcovers-somefavorincreasedradiopacity;jointlesscoilsforimprovedtorqueresponse;polymercoversforselectedapplicationsCoretapersandmaterials-shortertapersforimprovedtorqueresponse;gene

7、rallystainlesssteelCorediameters-largerforincreasedsupportandtorqueresponseCoatings-hydrophilicfortracking(body)andhydrophobicfortorqueresponse(bodyandtip)ASAHIMIRACLEBROS™3ASAHIMIRACLEBROS™4.5ASAHIMIRACLEBROS™6ASAHIMIRACLEBROS™12ASAHIMIRACLEBROS™F

8、amilyStraightTipGuideWiresCharacteristics:Core-to-tipdesign(uniquewiredrawingprocess)Non-taperedtip11cmofradiopacitySmoothtractability&deliverywithJoint-lessdistalcoiltechnologyHydrophobiccoatingIncreasingtiploads3-12gmExcellenttipshapeability&shape