冠状动脉钙化病变处置的技术和策略VIP免费

BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally冠状动脉钙化病变处理的技术与策略BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally有利于器械通过病变，提高操作成功率斑块改良:复杂病变变“简单”改变病变的顺应性减少血管损伤预防支架膨胀不良，获得理想的管腔直径减少贴壁不良理想的远期效果降低再狭窄降低支架血栓为什么要改良?BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyPart1旋磨装置Part2切割球囊Part3Angiosculpt积分球囊Part4双导丝聚力球囊Part5轨道旋切装置Part6临床应用要点技术与策略BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨装置BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨导管操纵器BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨头BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally控制台BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally差异切割钙化纤维组织有弹性的组织•清除纤维化或钙化斑块，弹性组织在高速旋磨头通过自动弹开•旋磨头不切割有弹性的组织和正常冠状动脉BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally控制颗粒大小•旋转速度160000～200000rpm时产生的颗粒<10～15μm，通过冠状动脉微循环被清除，不栓塞毛细血管•磨头推进时可产生热量，速度下降，在低速旋磨（<75000rpm）情况下可产生较大的颗粒红细胞旋磨后微颗粒BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨后病理学改变横断面光滑的向心性管腔电镜管腔表面光滑旋磨后管壁光滑不损伤中膜，夹层发生率低于球囊扩张BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally旋磨的应用趋势BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally2011AHA/ACC/SCAIPCI指南建议推荐级别证据级别旋磨用于球囊或支架难以通过钙化或纤维化病变IIaC不建议常规应用于原位或支架内再狭窄病变IIIAJACC2011;57:1920BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally2010ESC/EACTS血运重建指南EHJ2010:31;2501–2555建议推荐级别证据级别球囊或支架难以通过的严重钙化或纤维化病变ICBostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally2014ESC/EACTS血运重建指南EHJ2014:35;2541–2619BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyPart1旋磨装置Part2切割球囊Part3Angiosculpt积分球囊Part4双导丝聚力球囊Part5轨道旋切装置Part6临床应用要点技术与策略BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally切割球囊球囊非顺应性材料PTE型号：2～4mm，长度6mm、10mm和15mmBostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally切割球囊折叠时刀片形态膨胀时刀片形态3～4个纵向平行的微手术刀片，间隔90°～120°高度为0.010″（工作高度0.005～0.006″）宽度0.006″（工作宽度0.003″）3.5～4.0mm球囊有4个刀片，其他型号有3个刀片BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally西瓜籽现象球囊滑过病变损伤远端正常血管段常见于亲水涂层球囊和短球囊BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally工作机理普通球囊切割球囊扩张时刀片开始外露，切割斑块，减轻周向应力，以最小扩张力扩张靶病变，减轻损伤6atm时刀片有效切割...