li yue, m.d. the first affiliated hospital of harbin medical university stent or balloon delivery...
TRANSCRIPT
Li Yue, M.D.Li Yue, M.D.
The First Affiliated Hospital of
Harbin Medical University
stent or balloon Delivery
TRI: How to treat difficult
??
Guiding catheter Extra-support shape/ Increase size Deep seated Inner catheter Wire & balloon Stiffer wire Buddy wire / balloon Anchor wire / balloon Plaque modification Rota / cutting balloon Stent Shorter / flexible / small profile(BMS)
Tips and tricks for stent delivery
导引导管支撑力 被动支撑
(取决于直径、结构、导管与主动脉壁接触面积和夹
角)
主动支撑(术者操作获得)
Deep seating
JL4.0
被动支撑力直径越大、支持力越强。
Radial artery diameter
The frequency of this ratio (≥ 1.0) for 7 and 8 Fr sheaths was 71.5% and 44.9% in male patients and 40.3% and 24.0% in female patients.
Male ( mm ) Female ( mm )国外 3.1±0.6 2.8±0.6 魏盟 2.7±0.4 2.3±0.4
贾三庆 2.65±0.60 2.20±0.49
radial artery internal diameter / sheath external diameter
4% in patients with ratio >1 13% in patients with ratio <1
7F sheath external diameter = 3.0mm
The dosage of heparin, the diameter of radial artery
and the post-procedure compression pressure and
time were independent risk factors for RAO
Cathet Cardiovasc Diagn 1997;40:156–158
Sheathless GC system (Asahi Intecc, Japan)
hydrophilic GC + central dilator
桡动脉细又需强支撑、大内径导引导管怎么办 ?
The outer diameter of the 6.5 F sheathless GC (2.16 mm)
is smaller than a 5 F sheath (2.29 mm).
The outer diameter of the 7.5 F sheathless GC (2.49 mm)
is less than that of a 6 F sheath (2.62 mm).
Thicker than conventional guide catheters due to an addition layer of steel braiding and the hydrophilic coating, aids backup support.
After the diagnostic angiography, the sheath was exchanged f
or the sheathless catheter over a standard 150 cm J-tipped 0.
035-inch (Terumo®, Japan) wire.
Comparing the backup force between TFI and TRI
J Invasive Cardiol. 2005 Dec;17(12):636-41
It was found to be 60% greater
in TFI with a JL catheter, and
8% greater in TFI with a backup
(BL/EBU/XB) type catheter.
JL4.0
短头 Amplatz 导管
标准 短头
刮伤主动脉窦情况 大大降低,造成靶血 管撕裂、 夹层可能 降到最低
入冠不深,几乎没有 嵌顿现象
Heartrail II (Terumo, Japan)
long (120 cm) 5 Fr catheter (13 cm very soft end portion)
Absence of curve and the flexibility of its tip permit the
“child” catheter coaxial with the target vessel.
5 in 6 guiding catheter technique
Inner catheter
Filled with water that was kept at 37°C
5 mm/s
Switching to 5-in-6 system
7F AL-1; 3.5mm balloon
(Goodman, Japan)
The lumen size of the aspiration catheter as the size of SES is limited to 3.0 mm.
GuideLiner cath
Rapid exchange Flexible yellow 20 cm straight extension connected to
a stainless-steel push tube Results in an I.D. approximately 1F size smaller available in three sizes: 6F, 7F and 8F
Not recommend its use in target vessels of < 2.5 mm diameter
Softer tip and hydrophilic coating on inside and outside.
5-Fr ST01 has the coating only on the inside.
Catheterization and Cardiovascular Interventions 76:919–923 (2010)
(Terumo, Japan)
KIWAMI ST01
Backup support of GC
Circ Cardiovasc Interv. 2011 Apr 1;4(2):155-61
Trackability of GC
Using balloon-anchoring technique 5F child catheter could be advanced to 13.0 cm, w
hereas the 4F child catheter could be advanced to 15.
0 cm (P<0.005).
Provided >90% success rate for 51 lesions in which conventional techniques had failed.
Success may be contributed, in most part, by the
trackability of the 4F child catheter.
Does not usually compromise the coronary flow.
Cypher (3.0 × 18 mm)
Guiding catheter Increase size / extra-support shape Deep seated Inner catheter Wire & balloon Stiffer wire Buddy wire / balloon Anchor wire / balloon Plaque modification Rota / cutting balloon Stent Shorter / flexible / small profile(BMS)
Tips and tricks for stent delivery
Anchor wire
Buddy Wire & Buddy Balloon
Provide the guiding catheter stability
Straighten the tortuous segment of the artery
Deflect the stent delivery system away from
the calcified area
Buddy Balloon
Inflated Buddy Balloon
LMS / ostial LCX
Predilated
2.5 X 15 mm balloon
3.5 X 10 mm cutting balloon
LAD
1.25, 1.5 bur
4.5 X 32 mm Liberty could cross
3.5 X 20 mm balloon
Buddy wire
Buddy balloon (3.5 X 20 mm)
Inflation of the buddy balloon to 2 atm, the distal stent edge was deflected enough from the plaque to allow its passage
3.0/14-mm balloon was placed at the lesion, SES was
placed at the proximal lesion.
Just after balloon deflation, SES was delivered to the
lesion easily.
Anchor balloon
Anchor in side branch Anchor in same artery
Super anchor balloon
Buddy - in – jail (Distal)
Buddy - in – jail (Proximal)
Guiding catheter Increase size / extra-support shape Deep seated Inner catheter Wire & balloon Stiffer wire Buddy wire / balloon Anchor wire / balloon Plaque modification Rota / cutting balloon Stent Shorter / flexible / small profile(BMS)
Tips and tricks for stent delivery
旋磨头不能够通过怎么办 ?
Guiding catheter Increase size / extra-support shape Deep seated Inner catheter Wire & balloon Stiffer wire Buddy wire / balloon Anchor wire / balloon Plaque modification Rota / cutting balloon Stent Shorter / flexible / small profile(BMS)
Tips and tricks for stent delivery
Antegrade PCI used a Fielder and Miracle 3 wire unsucc
essful. A large dissection in the RV branch.
A Fielder wire was advan
ced into the aorta retrograd
ely.
The retrograde balloon (V
oyager 2.0 -20 mm) inflated in
RCA.
Multiple attempts to pass
a guidewire antegradely w
ere unsuccessful.
Retrogradely passed a
2.5- 8 mm Mini-Vision ste
nt to the RCA ostium.
Subsequently, 5 more
Vision stents (2.5-12, 2.5-1
5, 2.25-12, 2.25-15 and 2.25-2
3).
Because the patient had previously undergone CABG with the risk of perforation from epicardial collateral passage consequently decreased.
Seesaw balloon-Wire cutting 技术
Seesaw balloon-Wire cutting 技术
球囊“挤撬”反复冲击、扩张
1.25×10m
m
纤维帽
多导丝挤压
Pilot 50
Pilot 150
Pilot 150
Mini TREK
1.2×6 mm
Sprinter
1.5×6 mm
×
×
How to do next ?
Pilot 150
Pilot 50Tazuna
1.25×10 mm
Tazuna
1.25×10 mm
Seesaw balloon-Wire cutting
反复“交替”
Technique Features and PCI ResultsResults (n = 21)
Procedure success related to Seesaw balloon-wire cutting technique, n (%) 16 (76.2%)
Technical failure, n (%) 5 (23.8%)
Due to inability to place a second guidewire 1 (4.8%)
Due to balloon unable passing 4 (19.0%)
Category of the second guidewire, n (%)
Pilot 150 9 (42.8%)
Pilot 200 8 (38.2%)
Progress 200T 4 (19.0%)
Mean time of successful Seesaw balloon-wire cutting procedure (mean ± SD, min) 26.4 ±7.7
Application of additional technique, n (%)
Rotational atherectomy with Rotablator, n (%) 3 (14.3%)
Overall procedure success, n (%) 19(90.5%)
Seesaw balloon-wire cutting technique related serious complication, n(%) 0
Tips and tricks
Polymer-coated and more stiff guidewire (pilot 150
or 200 , Progress 200T ) as the second guidew
ire.
Short and low profile balloons (1.25×10mm tazun
a) are recommend .
More suitable for TRI or GC without
enough back-up support
JR4 JL3.5 AL1 AL2 BL3.0
Tazuna
1.25×10 mm
1.25×10 mm
Buddy-in-Jail
Tornus
One month later
Seesaw balloon-Wire cutting 技术
Journal of Invasive Cardiology Journal of Invasive Cardiology