颈动脉支架手术步课件

循序渐进建立标准

股动脉穿刺7For8F的套管针7F用于8mm以下的CarotidWallstent™Monorail™

8F用于10mm以下的CarotidWallstent™Monorail™1.建立动脉通道2.血管造影确定病变选择性颈总动脉造影.035”标准导丝4For5F造影导管ImagerIIHeadhunterorSidewinder3.指引导管定位

置stiff.035”导丝于颈外动脉通过Y接头，置指引导管于颈动脉分叉处下1-2cm移出.035”导丝4.

FilterWireEZ™动脉远端保护装置回撤鞘和输送鞘（附有滤网的导丝）分别置于不同的保护盘内黑色尾端：附有滤网的导丝和输送鞘白色尾端:回撤鞘

撤除输送鞘，远端滤网显露出来4-1FilterWireEZ™动脉远端保护装置

准备用肝素盐水在原位冲洗输送鞘取出附有滤网的导丝及输送鞘滤网头端浸泡于肝素盐水中，移动输送鞘向上覆盖滤网，排除空气导丝头端通过剥离鞘，置滤网导丝于Y阀中4-1FilterWireEZ™动脉远端保护装置

准备4-2FilterWireEZ™动脉远端保护装置

理想的位置选择

滤网环最顶点距离病变远端至少3cm4-2FilterWireEZ™动脉远端保护装置

理想的位置选择3cmminimum1.5cmminimum血管直径介于3.5–5.5mm之间5.5mm3.5mm4-2FilterWireEZ™动脉远端保护装置

理想的位置选择

滤网放置于至少有2cm长的直血管镍钛环距血管转弯处距离应>1cm4-2FilterWireEZ™动脉远端保护装置

理想的位置选择ImagerIIHeadhunterorSidewinderAstheWallstentdeploys,itshortensfrombothendstowardsthemiddle（可见到镍钛环已进入到鞘远端的标记中）视角2:confirmappositionwithcrescentshapeFLOW: 定期检查血流Advancethestentsothattheradiopaquemarkersarepositionedeithersideofthelesiontobestented滤网环最顶点距离病变远端至少3cm4-1FilterWireEZ™动脉远端保护装置

准备IfitisnecessarytoplaceasecondCarotidWallstentFilterWireEZ™动脉远端保护装置Contrastmediumcanbeinjectedthroughtheguidingcatheterallowaminimumoverlapof5mm视角1:Appearsapposed镍钛环距血管转弯处距离应>1cm滤网放置于至少有2cm长的直血管确定支架两端的标记在病变外端CarotidWallstent™DeploymentTechniqueReview4-2FilterWireEZ™动脉远端保护装置

理想的位置选择注意不要移动滤网肝素盐水5ml冲洗支架内腔，见盐水从导丝口流出4-3FilterWireEZ™动脉远端保护装置

进入&前进onehandandtwohandstech

buddywire?/4-3FilterWireEZ™动脉远端保护装置

进入&前进4-4FilterWireEZ™动脉远端保护装置

定位&释放视角1:Appearsapposed视角2:confirmappositionwithcrescentshape

视角2:Notapposed4-4FilterWireEZ™动脉远端保护装置

定位&释放

旋紧扭控器，固定导丝/滤网滤网定位，从两个不同的角度（垂直）造影以确定镍钛环是否紧贴血管壁通过剥离的方式，抽出输送鞘，释放滤网A:导丝的头端B:滤网远端标记C:输送鞘标记D:镍钛环E:滤网近端标记PredeploymentPostdeploymentABCDEABCDE4-4FilterWireEZ™动脉远端保护装置

定位&释放4–5FilterWireEZ™动脉远端保护装置

稳定&血流

随时稳定导丝交换器械时交换指引导管时4–5FilterWireEZ™动脉远端保护装置

稳定&血流定期检查血流如果血流较缓，须重新定位和释放如果血流停止，立即撤出，CheckFlow4–5FilterWireEZ™动脉远端保护装置

稳定&血流1.PLACEMENT: 确定滤网完全贴壁2.POSITION:手术的全过程中,保持滤网的位置不变3.FLOW: 定期检查血流4–5FilterWireEZ™动脉远端保护装置

稳定&血流4FilterWireEZ™动脉远端保护装置

定位&释放在病变远端植入好FWEZ™远端保护装置后，沿FWEZ™的导丝将球囊推送到病变处注意不要移动滤网5.球囊预扩张球囊预扩张是为增加支架的通过性作准备AstheWallstentdeploys,itshortensfrombothendstowardsthemiddleIfitisnecessarytoplaceasecondCarotidWallstentCAUTION:IfthetipoftheCarotidWallstentnoseconecatchesthedistalends,freeitwithgentlemovements!POSITION:手术的全过程中,保持滤网的位置不变堵住导丝口，继续冲洗，可见盐水从导管头端（鞘管头端标记处）流出，4-4FilterWireEZ™动脉远端保护装置

定位&释放如果血流停止，立即撤出，4-4FilterWireEZ™动脉远端保护装置

定位&释放4–5FilterWireEZ™动脉远端保护装置

稳定&血流4-4FilterWireEZ™动脉远端保护装置

定位&释放旋紧扭控器，固定导丝/滤网FLOW: 定期检查血流IfitisnecessarytoplaceasecondCarotidWallstent4-4FilterWireEZ™动脉远端保护装置

定位&释放DeploytheCarotidWallstentslowlyafewmillimetersatatimePostdeployment滤网放置于至少有2cm长的直血管4FilterWireEZ™动脉远端保护装置

定位&释放TheGuideCathetercannowbewithdrawnandtheprocedurecompletedinthenormalwayCarotidWallstent™Deployment6.颈动脉支架术CarotidWallstent™Monorail™Placement支架的准备：阅读指南确保无菌确定支架密封在鞘管内冲洗装置：

肝素盐水5ml冲洗支架内腔，见盐水从导丝口流出堵住导丝口，继续冲洗，可见盐水从导管头端（鞘管头端标记处）流出，InsertionLoadthestentcatheterontotheproximalendoftheFilterWireEX™guidewireandadvancetheCarotidWallstent™tothelesion沿着保护伞导丝送支架到病变处Maintainthedeliveryinstrumentasstraightaspossibleoutsidethebody保持体外输送系统尽量直Advancethestentsothattheradiopaquemarkersarepositionedeithersideofthelesiontobestented确定支架两端的标记在病变外端IfitisnecessarytoplaceasecondCarotidWallstent allowaminimumoverlapof5mm如果有用第二个支架，重叠部分最少要有5mm6.颈动脉支架术CarotidWallstent™DeploymentTechniqueReviewAstheWallstentdeploys,itshortensfrombothendstowardsthemiddle支架释放后，长度从两端向中间缩短PlacetheproximalanddistalX-raymarkersintheinnershaftoverlappingbothsidesofthestenosis内杆上支架两端的标记要超过狭窄的范围DeploytheCarotidWallstentslowlyafewmillimetersatatime释放支架需要较慢的速度Uptoabouthalfwayitispossibletorecapturethestentandre-positionit支架释放一半以上时，还可以重新回收，重新定位6.颈动脉支架术CarotidWallstent™DeploymentImmobilizethestainlesssteeltube固定不锈钢管SlidetheT-connectorgentlytowardstheblackreleasemarkeruntiltheCarotidWallstentis 50%deployed.在支架释放小于50%时，将T连接向黑色释放标记移动，CheckpositionofthepartiallydeployedCarotidWallstentwithinthestenosis检查狭窄病变内部分释放的支架Contrastmediumcanbeinjectedthroughtheguidingcatheter造影剂可以通过指引导管注入CAUTION:Donotpushthestainlesssteeltube!注意：千万不要推动不锈钢管6.颈动脉支架术CarotidWallstent™DeploymentImmobilizethestainlesssteeltubeagainWhentheCarotidWallstentisinitsfinalposition,gentlyslidetheT-connectoronthestainlesssteeltubetowardstheheartshapedhubuntilthestentiscompletelydeployed.Carefullyremovethestentcatheter,underfluoroscopicguidance,leavingtheguidewireinplace支架定位后，固定不锈钢管，向前推动T管，完全释放支架CAUTION:IfthetipoftheCarotidWallstentnoseconecatchesthedistalends,freeitwithgentlemovements!如果支架的头端触及滤网的远端，轻柔将其移开6.颈动脉支架术6.颈动脉支架术7.球囊后扩张后扩的目的：Ensuregoodin-flowandout-flowcharacteristic确保流速正常Goodstenttowallapposition支架贴壁更好CAUTION:CloselymonitortheECGtraceintheeventofbradycardiaduringthepostdilatationstep.注意：如果后扩时出现心动过缓，密切注意心电图轨迹.ControlAngiogram？？Performacontrolangiogramtoconfirmresultofstentplacement4-6FilterWireEZ™动脉远端保护装置

回撤4-6FilterWireEZ™动脉远端保护装置

回撤

沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内（可见到镍钛环已进入到鞘远端的标记中）将整个的回撤鞘连同滤网导丝作为一个整体同时撤出4-6FilterWireEZ™动脉远端保护装置

回撤4.

FilterWireEZ™动脉远端保护装置

FilterwireEZ“EASY”FinalResultsTheGuideCathetercannowbewithdrawnandtheprocedurecompletedinthenormalwayThankYouforyourAttention!注意：千万不要推动不锈钢管（可见到镍钛环已进入到鞘远端的标记中）5cmminimum视角1:Appearsapposed4-2FilterWireEZ™动脉远端保护装置

理想的位置选择滤网环最顶点距离病变远端至少3cm支架释放后，长度从两端向中间缩短3cmminimum7For8F的套管针PlacetheproximalanddistalX-raymarkersintheinnershaftoverlappingbothsidesofthestenosisallowaminimumoverlapof5mmAstheWallstentdeploys,itshortensfrombothendstowardsthemiddleCarotidWallstent™Monorail™Placement确定支架两端的标记在病变外端4–5FilterWireEZ™动脉远端保护装置

稳定&血流ImagerIIHeadhunterorSidewinder旋紧扭控器，固定导丝/滤网4-4FilterWireEZ™动脉远端保护装置

定位&释放AstheWallstentdeploys,itshortensfrombothendstowardsthemiddleFLOW: 定期检查血流

滤网环最顶点距离病变远端至少3cm4-2FilterWireEZ™动脉远端保护装置

理想的位置选择3cmminimum1.5cmminimum视角1:Appearsapposed视角2:confirmappositionwithcrescentshape

视角2:Notapposed4-4FilterWireEZ™动脉远端保护装置

定位&释放

旋紧扭控器，固定导丝/滤网滤网定位，从两个不同的角度（垂直）造影以确定镍钛环是否紧贴血管壁通过剥离的方式，抽出输送鞘，释放滤网4FilterWireEZ™动脉远端保护装置

定位&释放CarotidWallstent™DeploymentTechniqueReviewAstheWallstentdeploys,itshortensfrombothendstowardsthemiddle支架释放后，长度从两端向中间缩短PlacetheproximalanddistalX-raymarkersintheinnershaftoverlappingbothsidesofthestenosis内杆上支架两端的标记要超过狭窄的范围DeploytheCarotidWallstentslowlyafewmillimetersatatime释放支架需要较慢的速度Uptoabouthalfwayitispossibletorecapturethestentandre-positionit支架释放一半以上时，还可以重新回收，重新定位6.颈动脉支架术4-6FilterWireEZ™动脉远端保护装置

回撤allowaminimumoverlapof5mmCarotidWallstent™Monorail™PlacementAstheWallstentdeploys,itshortensfrombothendstowardsthemiddle撤除输送鞘，远端滤网显露出来MaintainthedeliveryinstrumentasstraightaspossibleoutsidethebodyPlacetheproximalanddistalX-raymarkersintheinnershaftoverlappingbothsidesofthestenosis确定支架两端的标记在病变外端ImagerIIHeadhunterorSidewinderFLOW: 定期检查血流Ensuregoodin-flowandout-flowcharacteristic视角2:confirmappositionwithcrescentshape4-6FilterWireEZ™动脉远端保护装置

回撤确定支架两端的标记在病变外端WhentheCarotidWallstentisinitsfinalposition,gentlyslidetheT-connectoronthestainlesssteeltubetowardstheheartshapedhubuntilthestentiscompletelydeployed.FilterwireEZFLOW: 定期检查血流allowaminimumoverlapof5mm035”导丝于颈外动脉FilterWireEZ™动脉远端保护装置5cmminimum4-1FilterWireEZ™动脉远端保护装置

准备buddywire?/视角2:confirmappositionwithcrescentshape滤网环最顶点距离病变远端至少3cmPOSITION:手术的全过程中,保持滤网的位置不变onehandandtwohandstech旋紧扭控器，固定导丝/滤网4-4FilterWireEZ™动脉远端保护装置

定位&释放沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内FLOW: 定期检查血流4–5FilterWireEZ™动脉远端保护装置

稳定&血流确定支架两端的标记在病变外端AstheWallstentdeploys,itshortensfrombothendstowardsthemiddle支架释放后，长度从两端向中间缩短ControlAngiogram？？支架的准备：4-3FilterWireEZ™动脉远端保护装置

进入&前进ImagerIIHeadhunterorSidewinderCarotidWallstent™DeploymentTechniqueReviewAstheWallstentdeploys,itshortensfrombothendstowardsthemiddleWhentheCarotidWallstentisinitsfinalposition,gentlyslidetheT-connectoronthestainlesssteeltubetowardstheheartshapedhubuntilthestentiscompletelydeployed.3cmminimumPOSITION:手术的全过程中,保持滤网的位置不变AstheWallstentdeploys,itshortensfrombothendstowardsthemiddle肝素盐水5ml冲洗支架内腔，见盐水从导丝口流出滤网环最顶点距离病变远端至少3cmCarotidWallstent™Monorail™Placement如果血流停止，立即撤出，4–5FilterWireEZ™动脉远端保护装置

稳定&血流视角2:confirmappositionwithcrescentshape滤网环最顶点距离病变远端至少3cm4–5FilterWireEZ™动脉远端保护装置

稳定&血流AstheWallstentdeploys,itshortensfrombothendstowardsthemiddleAstheWallstentdeploys,itshortensfrombothendstowardsthemiddle沿着滤网导丝，用回撤鞘将滤网完全地回收至鞘内Loa