冠状动脉介入治疗球囊的选择课件

冠状动脉介入治疗球1囊的选择徐州中心医院

吴强球囊分类整体交换球囊（OTW-

over

thewire)快速交换球囊

(monorail)Rapid

ExchangeGuidewireInflation

lumen&

guidewire

lumenInflation

lumen

onlyInflation

portOver-the-WireGuidewireInflation

lumen&

guidewire

lumenInflation

Port2球囊的结构球囊尖端球囊推送杆3球囊尖端4外径：直头－圆弧－锥形尖端与球囊的连接：胶水黏结－热焊接－激光焊接56球囊7球囊材料：尼龙、聚乙烯－球囊顺应性（顺应性/半顺应性/非顺应性）（顺应性=球囊直径/压力atm）折叠方式：零折叠、二折叠三层折叠：利于回卷，后撤，低折叠－减小通过半径。标记方式：中央标记－易于通过严重狭窄病变，双标记－

利于测量病变长度，与内杆关系（外包/内嵌）球囊肩部角度：球囊于尖部平滑过渡有利于通过病变球囊与中心杆的连接技术和材料：决定通过扭曲血管的能

力球囊表面亲水涂层有利球囊的通过性。开辟新纪元的零折叠技术零折叠8两折叠没有折叠的球囊材料球囊材料直接裹在远端球囊杆上，加压充盈成为一个球囊9Sprinter

Legend1.25&1.5mm金标记带在外杆上标记带处的球囊外径在同类产品中最小（0.024”）10Sprinter

Legend

1.25&1.5mm球囊标记带改放在球囊内杆上Sprinter

1.5mm铂金加銥标记带在内杆上11球囊性能12外径（crossing

profile)灵活性（flexibility)跟踪性（trackbility)推送性（pushbility)顺应性（compliance)球囊操作要领13预扩张14有利于支架的植入有利于病变的测量选择小于血管直径0.5-1mm的球囊进行预扩张，球囊长度应适当预扩张应尽量减少对正常血管的损伤，因此，大直径高压力只在必要时使用。为测量病变长度，使预扩张球囊在冠状动脉内进行造影时，注射造影剂的力度不宜过大，以免加重血管的撕裂对于狭窄程度重、较复杂的病变，预计支架通过较困难的

病变应常规充分地预扩张，尤其对初学者预扩张中的问题15球囊的通过性：严重的狭窄、钙化病变，闭塞病变（球囊选择、双导丝、锚定、

Tornus、旋磨)。球囊的扩张效果：钙化病变，较硬纤维斑块（切割、旋磨、双导丝+高压囊）。血管内超声（IVUS）:血管钙化16不同类型病变的球囊选择小血管病变：宜选用外形小，推进性好的球囊。还可选用耐高压球囊。扭曲病变：应选择外形较小、推进性好的球囊。OTW球囊推进性较单轨球囊好，还有利于交换导丝钙化病变：应选择外形较小、推进性好的球囊。还可选用双导丝、耐高压乳突或切割球囊，两根导丝加高压球囊，旋磨后球囊扩张。17后扩张18防止支架贴壁不良，预防支架内血栓形成，

降低再狭窄后扩张球囊可选择大一号的球囊或更高的压力后扩张时一定不能超出支架的边缘，尤其

是的DES不可盲目追求所有病例的大球囊高压力的后扩张，以免增加无再流和冠状动脉破裂的风险不同类型病变的球囊选择CTO

病变：常选择单标记、整体交换、小

外径（1.5-1.25-1.0

mm）球囊，如MaverickSprinter

Legend等长病变：原则上选用较长的球囊，以防两端撕裂并减少扩张次数。分叉病变：可选双导丝球囊、切割球囊。目的：减少斑块移位、降低分支闭塞的概率。19常用的球囊特点20Maverick®

PTCA

Balloon

CathetersProprietary

laser

bondedtechnology

createsanextraordinary

TrakTip™

Designand

precise,

smooth

bondsthroughout

theshaft.Push

coil

design

andimproveddistal

flexibility

for

enhancedtrackability.Our

1.5

and

2.0

mmSoftLEAP™Balloons

offerenhancedcrossability.21Apex™

PTCA

Dilatation

CatheterilelehhSlope™

Outer

Shaft

smoothly

transitionsfrom

stiff

to

flexible,

all

in

one

piece,

formore

efficient

pushtransmissionBi-Segment™

Inner

Shaft

optimizes

the balance

between

push

andtrackShorter,

thinner

marker

bands

increase distal

flexibilityRedesigned

tip

with

improved

flexibility

and wire

movement;same

ultra-low0.017"profiOptiLEAP™

Balloon

with

reduced

waist thickness

provides

great

sizing

flexibility

wit lowerprofilesNano-composite

materials

adds

structure

and pushability

to

the

outershaft22Quantum™

Maverick®

BalloonalLow

profile,

full

length

1.8F

or2.0F

Monorail™

shaftLow

profile

3.2F

proximal

over-the-wire

shaftBioslide™

Coating

on

aPEBAX®

Distal

ShaftLaser

bondingtechnologyQuantum

LEAP

Balloon

MateriTapered

TrakTip™

Designwith.017"

lesion

entryprofile*23242526NC

sprinter力；外形细小的FasTrac头端技术-可在遇到较难通过的病变时提供极佳的通过能力；

柔软耐用的Fulcrum

Plus球囊材料和MiniWrap折叠技术提供细小的外径和出色的再回抱能

选择性的Dura-Trac涂层使球囊在到达和通过病变的过程中保持持久的润滑，在球囊扩张

时保持稳定；渐细钢丝设计的推送杆增强了球囊的跟踪能

力和通过远端病变能力；光滑细小的导丝交换口使3.5mm以下的任何两个球囊可在6F（0.070"）的指引导管里对吻。27Sunflex

Tip

is

superbly

engineered

to

give

aperfect

balance

between

flexibility

and

kink

resistance.‘Zero’

transition

between

the

tip

and

wire

forsmoothestentry

profile.

Tapered

Tip:The

tapered

soft

tip

combinedwithadvanced

laser

welding

technology

providesthemost

competitive

tipprofile

Slidematrix

dual

coating

is

specially

formulatedwithtwo

unique

proprietary

blends.

Hydrophilic

and

Inviocoatings

are

applied

to

the

distal

leading

tip

sectionand

the

balloon/shaft

section,

respectively

to

providean

optimal

balance

between

lubricious

crossing

andminimizing

watermelon

seeding

Tight

Fold

processing

results

in

a

slenderprimary

profile

for

enhanced

crossabilitythrough

tight

lesions.Sapphire

NCOrbusNeich28The

IP

Transition

Zone

of

theAvitaPTCA

Dilatation

Catheter

providesintensified

pushability.The

new

tapered

tip

design

with

softmaterial

exhibits

a

flexible

tip

for

smoothlesion

entry

and

minimal

vessel

trauma.The

Invio

coating

on

the

innerlumeneliminates

friction

between

the

catheterand

guidewire.

Invio

is

also

applied

tothe

outer

distal

segment

from

the

tipto

the

exit

marker

zone

forlubriciouscrossability.Avita

HPOrbusNeich29RuginCrossTipTM

确保Ryugin通过性可以达到的最高性能。CrossTipTM

是

由特殊混合的弹性塑料聚合物制作而成。0.017

英寸(0.043毫米)的入口外径确保了Ryugin

在完全闭塞的病变的复杂管腔里的通过性。

CrossTipTM

中等长度的柔韧前端能较易地通过移植支架处的病变并绷紧其钙化病变。亲水涂层M-Coating，塑料聚合物的复合层和新一代金属合金的

Hypotube。使用Ryugin通过过度弯曲和大弯曲血管时，它能顺滑的到达目标病变部位，并且成功的处理其复杂闭塞病变。提供广泛有效的球囊直径选择范围—从超细的1.25毫米直径到4.0毫米直径不等。薄型聚酰胺球囊确保了其卓越的通过性RyuginCrossTip

是从尖端到薄型聚合物球囊的一段平滑过度部分，平滑柔韧的联合体能够通过各种复杂病变部位。泰尔茂新一代FC(Flexible

Corrugate)

轴管成为连接高弹性的前端轴管

和具备强硬金属的Hypotube

轴管之间的桥梁。

FC-shaft

是指经过加工的柔软的胶质轴，该技术实现了通过一个平衡轴加强力量的传输性和弹性。30VoyagerSuperb

Cross

Tapered

Tip

DesignNew

tapered

tip

with

.017”

tip

entry

profile

designed

to

cross

tight

lesionsImproved

tip-to-wire

conformability1

for

confident

track

andcrossPolyurethane

tip

material

is

flexible

yet

durable

for

toughlesionsFlexible

tungsten

marker

technology

allows

catheter

to

conform

to

tortuousanatomyMore

Options

—

Low

Profile

ShaftDesignVersatile

treatment

in

a

6F

guideExcellent

track

and

push

in

tortuous

anatomy

with

new

hypotube

designReinforced

mid-shaft

design

provides

flexibility

and

additionalsupportFlexibility

with

Visibility

—

Proprietary

Tungsten

MarkerNew

marker

material

comprised

of

tungsten

polymerFlexible

marker

design

allows

the

catheter

to

conform

more

easily

to

tortuousanatomyIncreased

marker

flexibility

helps

to

reduce

resistance

when

crossing

tight

lesionsPrecise

Dilatation

—

Proven

Balloon

PerformanceShort

tapers

allow

for

precise

dilatationImproved

LOFOLD

Balloon

Technology

processes

allows

for

excellent

rewrap

and

recross1XCELON

S

Balloon

Material

achieves

superb

flexibilityPowersailiirreetetennttPLATEAU

Balloon

MaterialProvides

non-compliance

at

high

pressure

without

compromisingperformanceFlexibility

and

conformability

for

excellent

deliverabilityLOFOLD

Balloon

TechnologyProvides

a

low

crossing

profile

for

exceptional

lesioncrossLOFOLD

balloon

technology

for

improved

balloon

rewrapSoft

Tip

DesignTapered

tip

design

creates

a

low

entry

profile

and

excellenttip-to-wconformability

for

easy

lesion

accessSoft

tip

provides

flexibility

for

negotiating

tortuosity

and

crossing

sstrutsDual

Swaged

Markers1.

Provide

lower

profiles

than

conventional

markers32为复杂病变设计的MINITREK33MINI

TREK独特的小底盘设计提供1.20

mm,1.50

mm和2.00

mm

的球囊

SafeCut

uses

dual

wire

mechanism

to

createfocused

force.It

hasa

built-in

0.011integralwire

external

to

the

balloon

to

help

tracktortuous

vessels

with

greatefficiency.A

standard

0.014

guidewire

that

delivers

thecatheter

to

the

target

lesion

also

participatesin

the

dilatation

process.

The

guidewire

exitport

is

located

at

the

proximal

part

of

theballoon.During

balloon

dilatation,

the

standard

guidewire

and

integral

wire

apply

controlledforce

to

facilitate

plaque

fractures

at

low

inflation

pressures.

The

same

application

alsohelps

minimize

balloon

slippage.SafeCut's

distal

leading

tip

profile

is

0.032"

tapered

to

0.028"

which

is

smaller

thanthoseof

other

focused

force

balloons.Balloons

with

embedded

blades

for

scoring

the

vessel

have

high

crossing

profiles

due

tothe

nature

of

the

balloon

materials

and

blades.The

integral

wire

and

standard

guidewire

apply

evenly

distributed

force

to

facilitatecontrolled

plaque

at

low

pressures,

reducing

trauma

to

the

vesselwall.Other

balloons

using

the