醫(yī)學(xué)課件腎動(dòng)脈支架植入術(shù)詳解

1、Clinical Indications(Procedures)Clinical Indications(ProcedurAnatomyAnatomyKidney anatomyKidney anatomyEndovascular Treatment of Renal Artery StenosesAim of the treatment1) Renovascular Hypertension 2) Renal InsufficiencyEndovascular Treatment of RenaRenovascular Hypertension5% of all hypertensive p

2、atientsDue to atherosclerosis or FMDDiagnosed after Surgical follow-up or PTRA.PTRA does not cure Essential Hypertension Renovascular Hypertension5% ofRenal InsufficiencyNephrosclerosis after RAS or occlusionPTRA is indicated to reverse or prevent the decline of kidney functions8cm long kidney is th

3、e lower limit after which kidney function might be compromisedRenal InsufficiencyNephrosclerIndications for PTRAFailed medical therapyReducing drug treatmentPressure gradient 10%More than 50% stenosisAssymmetrical loss of renal massIndications for PTRAFailed medEndovascular Treatment of Renal Artery

4、 Stenoses1) Treatment of artheriosclerotic ostial lesions (80%) dilatation + stenting2) Treatment of post ostial lesions dilatation (stenting if necessary)3) Treatment FMD dilatation (stenting if necessary)Endovascular Treatment of RenaPost-ostial lesionPost-ostial lesionFibro-Muscular DysplasiaFibr

5、o-Muscular DysplasiaFibro-Muscular DysplasiaFibro-Muscular DysplasiaRestenosis after stentingRecent studies have indicated rates are between 10-20% (much better than the 30% with just PTA).Restenosis after stentingReceTreatment OptionsMedical TreatmentPTA with StentingSurgeryDialysis: Renal Function

6、 never get betterTreatment OptionsMedical TreatGold standard treatment todayMedical treatmentACE inhibitors and a new class of Angiotensin receptor blockers Gold standard treatment todayEndovascular Options: PTA or Stenting ?1999: Peter Van de Ven, randomized trialPTA vs Stenting in ostial lesionPTA

7、StentingNumber of patients4243Primary patency rate29%75%Primary success rate57%88%Restenosis post-procedure48%14%Endovascular Options: PTA or SLiteratureLiteratureProduct Strategies014”Cardiologist, Radiologists, Vasc Surgeons.Balloon: M3 RxStents: Corinthian IQ on M3Wire, Stabilizer 7-8F Vista Brit

8、e Tip or IG035 Radiologist who are used to traditional PTA balloons, More range in PTA balloonsBalloons: P3, Opta ProStents: Genesis premounted on OPTA -PROWire 035, Jindo, Storq8F Vista brite Tip or IGProduct Strategies014”035 A new approach: .018 !A GOOD COMPROMISE !Radiologist who are used to tra

9、ditional PTA balloons, More range in PTA balloonsBalloons: SlalomStent: Genesis premounted on OPTA -PROWire 018, SV6-7F Vista brite Tip or IGA new approach: .018 !A GOOD CAdvantages of .014 systemsLess spasm with .014 wireLess wire lengthSmaller puncture siteStent protected by GCGood supportAdvantag

10、es of .014 systemsEndovascular Treatment of Renal Artery Stenoses Through the groin using 8F materialsCan be downsized to 7F using M3Endovascular Treatment of Rena醫(yī)學(xué)課件腎動(dòng)脈支架植入術(shù)詳解Emerald .035Emerald .035Emerald .035 + Pigtail Tempo 4-5F 65cmEmerald .035 + Pigtail Tempo 4Emerald .035 + Renal Curve Temp

11、o 4F 65cmEmerald .035 + Renal Curve TemEmerald .035 + Renal Curve Tempo 4F 65cmEmerald .035 + Renal Curve TemEmerald .035 + RDC Vista Brite Tip 8F 55cmEmerald .035 + RDC Vista BriteEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald

12、 .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro

13、Emerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQEmerald .035 + RDC VBT 8F 55cmEndovascular Treat

14、ment of Renal Artery Stenoses2) Through the groin using the new 6F materialsEndovascular Treatment of Rena醫(yī)學(xué)課件腎動(dòng)脈支架植入術(shù)詳解.014 Stabilizer.014 Stabilizer.014 Stabilizer + 6F Brite Tip Sheath 55cm.014 Stabilizer + 6F Brite Tip.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm .014

15、Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F BTS 55cm + M3.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F B

16、TS 55cm + M3.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F BTS 55cm + Corinthian IQ on M3.014 Stabilizer + 6F BTS 55cm .014 Stabilizer + 6F BTS 55cm + Corinthian IQ.014 Stabilizer + 6F BTS 55cm Endovascular Treatment of Renal Artery Stenoses3) Through a brachial accessEndovascular Treatment of R

17、enaTempo 4F MP + .014 StabilizerTempo 4F MP + .014 StabilizerBrite Tip Sheath 6F 90cm + .014 StabilizerBrite Tip Sheath 6F 90cm + .01Brite Tip Sheath 6F 90cm + .014 StabilizerBrite Tip Sheath 6F 90cm + .01Brite Tip Sheath 6F 90cm + RDC Tempo 4F +.014 StabilizerBrite Tip Sheath 6F 90cm + RDCBTS 6F 90

18、cm +.014 StabilizerBTS 6F 90cm +.014 StabilizerBTS 6F 90cm +.014 Stabilizer + M3BTS 6F 90cm +.014 Stabilizer +BTS 6F 90cm +.014 Stabilizer + M3BTS 6F 90cm +.014 Stabilizer +BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3BTS 6F 90cm +.014 Stabilizer +BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3BTS 6F 90cm +.014 Stabilizer +