閉環(huán)支架優(yōu)勢.inservice專業(yè)教育

1、1boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.confidential information of boston scientific corporation. do not copy or distribute.閉環(huán)設(shè)計優(yōu)勢閉環(huán)設(shè)計優(yōu)勢carotid wallste

2、nt and filterwire ez system2boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.不同支架設(shè)計不同支架設(shè)計 開環(huán)設(shè)計開環(huán)設(shè)計 閉環(huán)設(shè)計閉環(huán)設(shè)計 carotid wallstenttm precisetmacculinktm3boston scienti

3、fic confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.confidential information of boston scientific corporation. do not copy or distribute.閉環(huán)單元設(shè)計閉環(huán)單元設(shè)計4boston scientific confidentia

4、l - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.閉環(huán)單元設(shè)計的三大要素閉環(huán)單元設(shè)計的三大要素主要目的：通過臨床數(shù)據(jù)的支持整合閉環(huán)設(shè)計的三大組成以將主要目的：通過臨床數(shù)據(jù)的支持整合閉環(huán)設(shè)計的三大組成以將carotid wallstent區(qū)分區(qū)分于其他頸動脈支架于其他頸動脈支架stentlumen徑向支撐力徑向支撐力支架網(wǎng)孔面積支架網(wǎng)

5、孔面積單元結(jié)構(gòu)設(shè)計單元結(jié)構(gòu)設(shè)計5boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.confidential information of boston scientific corporation. do not copy or distribute.支架網(wǎng)孔面積如何影響臨床

6、結(jié)果支架網(wǎng)孔面積如何影響臨床結(jié)果? ?6boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.cas的目的的目的cas的目的是預(yù)防卒中的目的是預(yù)防卒中的再次發(fā)生的再次發(fā)生卒中是第三大死因，且是致殘卒中是第三大死因，且是致殘的首要因素的首要因素. .*data on file at

7、 bsc. 67boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.頸動脈支架的植入頸動脈支架的植入防止斑塊的脫落是首要目的！防止斑塊的脫落是首要目的！斑塊覆蓋是最重要的！斑塊覆蓋是最重要的！8boston scientific confidential - for inter

8、nal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.支架網(wǎng)孔面積支架網(wǎng)孔面積 不同的支架不同不同的支架不同cws的網(wǎng)孔面積只有的網(wǎng)孔面積只有acculink的的1/109boston scientific confidential - for internal use only. do not copy, display or distribute exter

9、nally confidential information of boston scientific corporation. do not copy or distribute.閉環(huán)單元設(shè)計優(yōu)勢閉環(huán)單元設(shè)計優(yōu)勢benefit #1 支架網(wǎng)孔面積支架網(wǎng)孔面積10boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not

10、copy or distribute.does carotid stent design influence outcomes? r. m. bersin, catheterization and cardiovascular interventions 2008; 72:863866目前為止，已經(jīng)完成3項有關(guān)頸動脈支架設(shè)計與臨床結(jié)果的回顧性、非隨機研究。1.does free cell area influence the outcome in carotid artery stenting? bosiers et al. a retrospective analysis of 30 day

11、 outcomes of a carotid artery stenting multicenter database consisting of 3179 consecutive patients2.space, a retrospective, randomized trial of carotid artery stenting versus endarterectomy in standard surgical risk patients with symptomatic carotid artery stenoses3.schillinger m, gschwendtner m, r

12、eimers b, et al. does carotid stent cell design matter? a retrospective, nonrandomized review of a carotid artery stenting multicenter database consisting of 1,684 consecutive patientsdoes carotid stent design influence outcomes? bersin. catheterization and cardiovascular interventions 2008; 72:8638

13、66. 11boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc su

14、rg 2007;33:135-141. 目的: 明確頸動脈支架設(shè)計，尤其是支架網(wǎng)孔面積，對于頸動脈支架術(shù)后30天卒中、死亡或tia的影響。 30天結(jié)果的回顧性分析 tia，死亡, 大和小卒中(非心肌梗死) 共3179接受頸動脈支架手術(shù)的患者 4個中心 bosiers, deloose - belgium peeters, verbis - belgium setacci, donato et al. - italy cremonesi, castriota - italydoes free cell area influence the outcome in carotid artery st

15、enting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 12boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.does free cell area influence the outcome in c

16、arotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 閉環(huán)支架定義為支架網(wǎng)孔面積 5.0mm2 例如precise rx nitinol stent systemrx acculink carotid stentdoes free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. precise is a

17、trademark of cordis corporation, acculink is a trademark of abbott cardiovascular systems, inc, and xact is trademark of mednova, ltd.13boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do

18、not copy or distribute.第30天事件：閉環(huán) vs. 開環(huán)支架設(shè)計tia, 死亡, 大和小卒中does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 對于癥狀性患者，術(shù)后第對于癥狀性患者，術(shù)后第30天的主要事件發(fā)生率差異顯著天的主要事件發(fā)生率差異顯著開環(huán)支架設(shè)計開環(huán)支架設(shè)計(7.0%) vs 閉環(huán)支架設(shè)計閉環(huán)支架設(shè)計(2.2%) (p0.0001)does free cell a

19、rea influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. n=3179p=0.005n=1317p0.0001n=1862p=1.01314boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific

20、corporation. do not copy or distribute.does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 術(shù)后=(tia, 卒中, 死亡) 直到術(shù)后30天發(fā)生 閉環(huán) vs. 開環(huán)支架設(shè)計does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vas

21、c endovasc surg 2007;33:135-141. 對于癥狀性患者，手術(shù)對于癥狀性患者，手術(shù)30天天以后的主要事件發(fā)生率差異以后的主要事件發(fā)生率差異顯著顯著開環(huán)支架設(shè)計開環(huán)支架設(shè)計(6.3%) vs 閉環(huán)支架設(shè)計閉環(huán)支架設(shè)計(1.3%) (p0.0001)n=3179p0.0001n=1317p0.0001n=1862p=1.014 of 74 uspv4035.174.0 15boston scientific confidential - for internal use only. do not copy, display or distribute externally

22、confidential information of boston scientific corporation. do not copy or distribute. 患者評估 由獨立神經(jīng)病學(xué)醫(yī)師進行神經(jīng)學(xué)上的 局限性 回顧性的研究 非隨機設(shè)計可能導(dǎo)致在選擇時會因特定病變類型有所偏向 注冊數(shù)據(jù)受制于自我審計 技術(shù)復(fù)雜性沒有評估，結(jié)果沒有經(jīng)過風(fēng)險校正 有必要進行前瞻性的隨機研究來比較不同支架網(wǎng)孔面積以得到最終結(jié)論does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j

23、vasc endovasc surg 2007;33:135-141. does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 16boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of bosto

24、n scientific corporation. do not copy or distribute.總結(jié)總結(jié) 四個中心的30天結(jié)果回顧性分析 n=3179 cas patients 對于癥狀性患者，術(shù)后第30天的主要事件發(fā)生率差異顯著，開環(huán)支架設(shè)計(7.0%) vs 閉環(huán)支架設(shè)計(2.2%) (p0.0001) 對于癥狀性患者，手術(shù)30天以后的主要事件發(fā)生率差異顯著，開環(huán)支架設(shè)計(6.3%) vs 閉環(huán)支架設(shè)計(1.3%) (p0.0001)does free cell area influence the outcome in carotid artery stenting? bosie

25、rs et al. eur j vasc endovasc surg 2007;33:135-141. does free cell area influence the outcome in carotid artery stenting? bosiers et al. eur j vasc endovasc surg 2007;33:135-141. 17boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential info

26、rmation of boston scientific corporation. do not copy or distribute.confidential information of boston scientific corporation. do not copy or distribute.單元結(jié)構(gòu)設(shè)計如何影響臨床結(jié)果單元結(jié)構(gòu)設(shè)計如何影響臨床結(jié)果? ?18boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential

27、 information of boston scientific corporation. do not copy or distribute.閉環(huán)單元設(shè)計優(yōu)勢閉環(huán)單元設(shè)計優(yōu)勢benefit #2-benefit #2-更光滑平整的內(nèi)腔更光滑平整的內(nèi)腔當(dāng)使用閉環(huán)設(shè)計支架時，血栓保護裝置掛在支架上的發(fā)生率更低當(dāng)使用閉環(huán)設(shè)計支架時，血栓保護裝置掛在支架上的發(fā)生率更低19boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential

28、information of boston scientific corporation. do not copy or distribute.閉環(huán)與開環(huán)支架設(shè)計的腔內(nèi)影像閉環(huán)與開環(huán)支架設(shè)計的腔內(nèi)影像20boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.支架單元設(shè)計如何影響器

29、械的交換支架單元設(shè)計如何影響器械的交換輸送鞘的回撤輸送鞘的回撤復(fù)雜解剖結(jié)構(gòu)會增加回撤的困難閉環(huán)單元設(shè)計的支架顯示出優(yōu)勢首選回收鞘管設(shè)計: 同軸系統(tǒng) 軟頭快速交換系統(tǒng)sharp entry anglesharp exit angledr. s.myla bsc carotid symposium tct 20052021boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston sci

30、entific corporation. do not copy or distribute.單元結(jié)構(gòu)設(shè)計的體內(nèi)比較單元結(jié)構(gòu)設(shè)計的體內(nèi)比較courtesy of dr. hoffmann開環(huán)支架開環(huán)支架acculink閉環(huán)支架閉環(huán)支架carotid wallstent一個病人，兩種支架，兩種截然不同的結(jié)果！一個病人，兩種支架，兩種截然不同的結(jié)果！22boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential informati

31、on of boston scientific corporation. do not copy or distribute.輸送裝置回收對比：開環(huán)輸送裝置回收對比：開環(huán) vs. 閉環(huán)單元支架閉環(huán)單元支架 dr. myla在閉環(huán)支架中，更容易回收球囊導(dǎo)管、支架輸送系統(tǒng)和血栓保護裝置，在閉環(huán)支架中，更容易回收球囊導(dǎo)管、支架輸送系統(tǒng)和血栓保護裝置，掛在支架連接桿上的發(fā)生率更低掛在支架連接桿上的發(fā)生率更低23boston scientific confidential - for internal use only. do not copy, display or distribute extern

32、ally confidential information of boston scientific corporation. do not copy or distribute.confidential information of boston scientific corporation. do not copy or distribute.24boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential informat

33、ion of boston scientific corporation. do not copy or distribute.閉環(huán)單元設(shè)計優(yōu)勢閉環(huán)單元設(shè)計優(yōu)勢benefit #3 徑向支撐力徑向支撐力當(dāng)使用閉環(huán)設(shè)計支架時，術(shù)后低血壓的發(fā)生率更低當(dāng)使用閉環(huán)設(shè)計支架時，術(shù)后低血壓的發(fā)生率更低! !25boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific co

34、rporation. do not copy or distribute.頸動脈分叉的解剖結(jié)構(gòu)頸動脈分叉的解剖結(jié)構(gòu)頸內(nèi)動脈具有壓力感受器頸內(nèi)動脈具有壓力感受器壓力感受器的主要作用是維持動脈血壓，以保證組織得到適量的血液供應(yīng)壓力感受器的反應(yīng)直接與壓力范圍相關(guān)（外部或內(nèi)部壓力）。壓力增大會引起壓力感受器反射性的降低血壓，造成低血壓。26boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of bos

35、ton scientific corporation. do not copy or distribute.徑向支撐力與低血壓的關(guān)系徑向支撐力與低血壓的關(guān)系支架的釋放產(chǎn)生向外的徑向支撐力支架的釋放產(chǎn)生向外的徑向支撐力，對頸動脈產(chǎn)生壓迫，對頸動脈產(chǎn)生壓迫壓力感受器感受到壓力的變化，并刺激迷走中樞，反射性的引壓力感受器感受到壓力的變化，并刺激迷走中樞，反射性的引起血管擴張起血管擴張 預(yù)擴張預(yù)擴張 (pta)產(chǎn)生對頸動脈的產(chǎn)生對頸動脈的壓迫壓迫低血壓低血壓術(shù)后術(shù)后+24 hrs低血壓低血壓術(shù)中術(shù)中*baroreceptors quickly respond to small changes in b

36、lood pressure. they fail to respond to higher pressure levels after one or more days. treatment of hypotension may cause complications for hypertensive patients. katzen presentation cirse 2006.慢性慢性*急性急性回撤球囊回撤球囊即可解決低血壓問題即可解決低血壓問題藥物控制藥物控制27boston scientific confidential - for internal use only. do not

37、 copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.徑向支撐力與抗血管回縮能力的區(qū)別徑向支撐力與抗血管回縮能力的區(qū)別“支架自我向外擴張的能力支架自我向外擴張的能力”“支架抵抗管壁回縮的能力支架抵抗管壁回縮的能力”stentlumenlumenstent28boston scientific confidential - for internal use only. do not copy, display or distribute externally confidential information of boston scientific corporation. do not copy or distribute.不同類型支架的徑向支撐力不同類型支架的徑向支撐力*source: boston scientific stent test report #90155656鈷鉻合金編織支架鈷鉻合金編織支架鎳鈦合金雕刻支架鎳鈦合金雕刻支架carotid wallstentnexstentexponentxactacculinkprotgprecise2829b