SOLITAIRE顱內(nèi)支架介入治療PPT演示課件

顱內(nèi)支架概覽1顱內(nèi)支架分類22顱內(nèi)輔助支架的作用問題：寬的瘤頸使得動(dòng)脈瘤內(nèi)的彈簧圈容易移位或部分脫出到載瘤動(dòng)脈里，這可能造成嚴(yán)重的并發(fā)癥。解決方案：顱內(nèi)輔助支架主要用于輔助寬頸動(dòng)脈瘤的彈簧圈栓塞，防止彈簧圈的移位或部分脫出。33支架的基礎(chǔ)知識(shí)與常用術(shù)語LOREMIPSUMDOLOR45開環(huán)vs.閉環(huán)閉環(huán)設(shè)計(jì)開環(huán)設(shè)計(jì)“游離”的尖端56顱內(nèi)支架不同的網(wǎng)眼設(shè)計(jì)SolitaireAB-閉環(huán)LeoPlus–閉環(huán)Neuroform–開環(huán)Enterprise–閉環(huán)未連接點(diǎn)67輸送性和可回收性輸送性：支架能夠被輸送到病變部位的能力，尤其是通過遠(yuǎn)端病變或通過迂曲的解剖結(jié)構(gòu)的能力。可回收性：支架被釋放后，可以被重新收回且被重新放置到更優(yōu)位置的能力。這是一項(xiàng)非常重要的能力，分為完全回收和部分回收。7柔軟性Flexibility為柔軟性，支架在閉合狀態(tài)下隨血管的彎曲而彎曲的能力。柔軟性越好，支架的通過性越佳。889順應(yīng)性Comfortability，支架在打開狀態(tài)下隨血管的彎曲而彎曲的能力。順應(yīng)性好，有利于支架完全貼壁和保持血管的正常生理彎曲。順應(yīng)性差可能導(dǎo)致血栓的形成910支架的貼壁性支架的貼壁性：支架與血管壁貼合的能力。貼壁性不好可能導(dǎo)致血栓和支架移位的發(fā)生10徑向支撐力是支架對(duì)血管壁的支撐能力-決定支架對(duì)彈簧圈的支撐能力-衡量支架的穩(wěn)定性和移位效應(yīng)111112開環(huán)vs.閉環(huán)1213毛刺現(xiàn)象和打折現(xiàn)象毛刺現(xiàn)象：Gator-Backing，指支架被置于彎曲解剖處時(shí)，網(wǎng)絲向外擴(kuò)張/伸出的趨勢。類似鱷魚背脊。打折現(xiàn)象：支架的彎曲能力，彎曲能力差支架容易在彎曲處發(fā)生打折現(xiàn)象，容易造成血管的閉塞1314支架短縮？支架釋放/撐開前后軸向上長度的差異所有支架都有一定程度的短縮取決于支架的材質(zhì)和設(shè)計(jì)對(duì)支架的精確釋放有重要的意義，但.如果支架可以完全回收重新放置，<20%的短縮率是可以接受的(如SolitaireAB)如果支架不能回收和重新放置，就需要有更低的短縮率1415金屬/血管比？在覆蓋支架的血管部位，支架的金屬表面積/血管表面積該指標(biāo)目前尚不能用于反映顱內(nèi)支架的性能低金屬/血管比可能降低管壁的不良反應(yīng)。1516潛在并發(fā)癥1支架內(nèi)再狹窄（In-stentrestenosis）:

狹窄是血管腔的變窄或阻塞。當(dāng)支架植入血管后，血管壁的內(nèi)皮被損傷，機(jī)體對(duì)損傷進(jìn)行一系列主動(dòng)修復(fù)。雖然此種修復(fù)是必要的，但在一些情況下，這種修復(fù)可能過度過度的修復(fù)可能導(dǎo)致疤痕組織在支架內(nèi)聚集，導(dǎo)致血管腔的狹窄或阻塞，這稱為“支架內(nèi)再狹窄”?？赡軐?dǎo)致腦缺血性損傷。1617潛在并發(fā)癥2血栓（thrombosis）:支架植入后，可能導(dǎo)致血栓形成。-急性、亞急性-遲發(fā)型可能導(dǎo)致腦缺血性卒中。1718潛在并發(fā)癥3支架移位邊支閉塞其他..18SolitaireAB產(chǎn)品信息LOREMIPSUMDOLOR1920*NotapprovedforsaleintheUnitedStates.

"InternalUseonly"Forev3Inc.PresentationUseOnly–NotforDistribution202021產(chǎn)品結(jié)構(gòu)圖解脫點(diǎn)推送導(dǎo)絲導(dǎo)入鞘全長有用長度遠(yuǎn)端標(biāo)記近端標(biāo)記"InternalUseonly"Forev3Inc.PresentationUseOnly–NotforDistribution21

21SolitaireAB的產(chǎn)品特點(diǎn)222223輸送推送導(dǎo)絲:0.016”的推送導(dǎo)絲，同彈簧圈的推送一樣簡便微導(dǎo)管4mm支架使用0.021”Rebar6mm支架使用0.027”Rebar輸送和釋放可一人操作可用于遠(yuǎn)端和迂曲的血管2324產(chǎn)品型號(hào)至少保證支架釋放后能夠覆蓋瘤頸兩端各4mm的距離，即有用長度至少超出瘤頸寬度8mm2425支架短縮

短縮主要發(fā)生在尺寸較大的血管里SolitaireAB的短縮主要發(fā)生在近端

有用長度不發(fā)生短縮

回收區(qū)是發(fā)生短縮的主要位置，釋放后

先確保支架遠(yuǎn)端準(zhǔn)確覆蓋了動(dòng)脈瘤遠(yuǎn)端4mm，釋放，瘤頸近端也可以達(dá)到4mm的覆蓋。25Solitaire?AB支架重疊-4mm26支架重疊的中點(diǎn)正對(duì)支架近端標(biāo)記.2627Solitaire?AB支架重疊-6mm2728支架網(wǎng)眼重疊試驗(yàn)—1st釋放C0.991.691.340.250.671.450.95CellA0.65CellBCellCAB2829支架網(wǎng)眼重疊試驗(yàn)—2nd釋放ACB0.721.100.95CellA0.340.820.911.151.441.77CellBCellC2930支架網(wǎng)眼重疊試驗(yàn)—3rd釋放ABC0.430.970.97CellA0.320.610.69CellB1.771.902.62CellC3031解脫SolitaireAB使用NDS-2解脫盒電解脫.解脫時(shí):輕微回撤微導(dǎo)管，暴露解脫點(diǎn)保持微導(dǎo)管在解脫點(diǎn)近端1-2mm處可以在填圈前或后解脫31支架操作過程LOREMIPSUMDOLOR3233器械尺寸選擇根據(jù)病變情況參考說明書選擇SOLITAIRE?AB及微導(dǎo)管:SolitaireAB與Rebar配合使用支架尺寸1）直徑：參考目標(biāo)血管節(jié)段的近端、遠(yuǎn)端的較大直徑尺寸2）長度：需要保證其有用長度能夠覆蓋動(dòng)脈瘤頸兩端各4mm的距離。33操作動(dòng)畫（可替代操作圖示）..\..\..\..\..\..\Product\SolitaireAB\Solitaire_AB.exe343435操作--微導(dǎo)管到位推送微導(dǎo)管到合適的位置：確保當(dāng)支架釋放后，支架兩端能夠覆蓋瘤頸兩端各4mm的距離。3536操作圖示—插入支架將導(dǎo)引鞘部分插入RHV旋緊RHV持續(xù)滴注，確認(rèn)可見液體從導(dǎo)引鞘近端流出363637操作圖示—插入支架旋松RHV推送導(dǎo)引鞘直到穩(wěn)定在微導(dǎo)管的卡口處旋緊RHV輕柔的向前推送theSOLITAIRE?AB進(jìn)入微導(dǎo)管373738操作圖示—支架到位和釋放當(dāng)支架推送導(dǎo)絲的柔軟部分完全進(jìn)入微導(dǎo)管的尾端，撤掉導(dǎo)引鞘一直推送SOLITAIRE?AB直到支架遠(yuǎn)端標(biāo)記到達(dá)微導(dǎo)管的末端，確保在支架釋放后，能夠充分覆蓋瘤頸兩端至少4mm的距離。注：推送過程中如遇很大阻力請(qǐng)停止推送3839操作圖示—支架到位和釋放保持支架位置不動(dòng)，小心回撤微導(dǎo)管，釋放支架。為達(dá)到支架的充分釋放，微導(dǎo)管需要撤到支架近端標(biāo)記的近端。>4mm>4mm3940操作圖示—支架的回收和重新釋放支架回收：保持支架位置不動(dòng)，小心推送微導(dǎo)管，直到支架全部收到微導(dǎo)管里。SOLITAIRE?AB可以完全回收2次。4041操作圖示--填彈簧圈將微導(dǎo)管（遠(yuǎn)端頭端≤2.5F）通過支架網(wǎng)眼送入動(dòng)脈瘤內(nèi)，填圈。41解脫–使用NDS-2解脫盒42解脫原理43|InsertionNeedle（鋼針）SolitaireABDetachmentZone（支架解脫點(diǎn)）解脫點(diǎn)的金屬結(jié)構(gòu)在外部電流到達(dá)、然后離開的過程中發(fā)生電解腐蝕。如SolitaireAB的電流途徑是：電流從解脫盒發(fā)出，到達(dá)支架解脫點(diǎn)；支架解脫點(diǎn)發(fā)生電解腐蝕；然后電流通過導(dǎo)電途徑到達(dá)鋼針。完整的電流回路是解脫的必要條件)（雖然鋼針也接收到電流，但是由于有一定的保護(hù)，所以結(jié)構(gòu)上不會(huì)受到影響）促進(jìn)電流運(yùn)動(dòng)的因素：鹽水沖洗肌肉（+）（-）4344解脫盒參數(shù)電壓(9V)電流1mA按鈕：‘Stop’‘Start’‘On’‘Timer’顯示解脫過程正消耗的時(shí)間(分.秒).最長解脫時(shí)間:2分鐘ThisispictureofNDS-14445配件連接線:-1副消毒針(20Gor22G)4546DetachmentZoneDetachmentZonePushWireIntroducerSheathTotalLengthUsableLengthDistalMarkersProximalMarker"InternalUseonly"Forev3Inc.PresentationUseOnly–NotforDistribution46ElectrolyticDetachmentCR00049Rev.BNotavailableforsaleintheUnitedStates4647準(zhǔn)備和檢測使用新電池:電池指示燈常亮：電量足夠電池指示燈閃爍：更換電池將連接線接頭插到解脫盒上，并旋緊確保連好。打開開關(guān)‘On’,聽到一短提示音檢測：按‘Stop’鈕，所有數(shù)字顯示‘8’.4748患者與器械的連接患者將消毒針插在肩膀(或腹股溝處)將“黑線”卡在鋼針上。Solitaire將“紅線”卡在支架推送導(dǎo)絲的近端無PTFE涂層處暴露解脫點(diǎn)（確保微導(dǎo)管未覆蓋支架解脫點(diǎn)）。4849解脫按“Start”開始解脫電壓框顯示解脫電壓(0.0to9.9volts).如果電壓顯示0.0伏,可能有短路存在，請(qǐng)重新檢查連接如解脫成功，則：解脫盒發(fā)出周期性重復(fù)的報(bào)警聲“Detach”燈常亮或解脫2分鐘后，解脫盒發(fā)出周期性重復(fù)的報(bào)警聲..\..\..\..\..\..\Product\SolitaireAB\Solitaire_AB.exe49操作動(dòng)畫..\..\..\..\..\..\Product\SolitaireAB\Solitaire_AB.exe505051成功的支架釋放DetachedStent5152SOLITAIRE?AB的輸送與輸送彈簧圈一樣簡便，最小使用ID0.021”的微導(dǎo)管輸送。柔軟性好，易于通過迂曲的血管。使用簡便支架應(yīng)用5253支架應(yīng)用DistalmarkersProximalmarker輔助支撐彈簧圈

貼壁性好

徑向支撐力好

可視性佳53磁共振成像相容性

03April2023|Confidential54|54異議處理5556防止填圈過程中支架解脫假陽性解脫（未解脫）假陰性解脫（解脫了）5657防止填圈過程中支架解脫如希望在填圈后解脫支架，則手術(shù)過程中可以:用微導(dǎo)管覆蓋支架解脫點(diǎn)在解脫彈簧圈時(shí)，用干布覆蓋推送導(dǎo)絲近端（體外）如果導(dǎo)絲交叉可能出現(xiàn)交叉電流，導(dǎo)致支架過早解脫。避免推送導(dǎo)絲交叉干布覆蓋支架推送導(dǎo)絲5758假陽性解脫（未解脫）解脫盒已經(jīng)報(bào)警顯示解脫，但實(shí)際上未解脫58解脫的優(yōu)化方法：解脫前：消毒針插在患者肩膀或頸部。在針頭處滴幾滴生理鹽水。消毒針插在肌肉層里。使用9V新電池。使用新電解線。5959優(yōu)化方法：解脫中：確保微導(dǎo)管中持續(xù)快速滴注生理鹽水避免消毒針插在脂肪層支架近端標(biāo)記與微導(dǎo)管遠(yuǎn)端標(biāo)記之間距離<2mm支架推送導(dǎo)絲近端在干燥的操作臺(tái)表面確保卸掉微導(dǎo)管與支架推送導(dǎo)絲上的力量6060國外醫(yī)生經(jīng)驗(yàn)方法：針頭處滴幾滴生理鹽水按‘Stop’重置，按‘Start’再次解脫換用BSC的解脫器616162假陰性釋放（解脫了）醫(yī)生看到支架解脫但解脫盒10秒后仍未報(bào)警(解脫盒設(shè)定程序?yàn)榻饷摵?秒報(bào)警）:建議等待解脫時(shí)間至2分鐘，透視下辨別62中斷解脫6364中斷解脫并繼續(xù)解脫按“STOP”可以中斷“timer”停止計(jì)時(shí)電流(0.0mA)和電壓(“-.-”)被切斷.重新開始請(qǐng)短按(<1秒)“START”.電流和電壓重新顯示，“timer”繼續(xù)計(jì)時(shí)6465線路連接導(dǎo)致的解脫中斷如果患者方的連接中斷,解脫盒可以識(shí)別并長報(bào)警及“Detach”燈亮。檢查線路，確保正確連接。按STOP，“timer”數(shù)值將歸0。按START重新開始。6566重置Timer重新解脫（timer重新顯示“0.0”并重新計(jì)時(shí)）可以長按START重置所有參數(shù)Timer歸"00.00".常規(guī)步驟解脫。66StentingTechniquesLOREMIPSUMDOLOR6768SingleStentUseofasinglestent:Placestent,detach,placecoilsthruthestrutsPlacestent,placecoilsthruthestruts,detachPlacecatheter,placestentsocatheteris‘jailed’alongthestent,placecoilsPlacethestent,detach,letitendothelializeforafewdays,gobackinandcoilthruthestrutsUsageofstentasatemporaryassist–reinforcestheadvantageofdeploymentandretrieval–forcasesthatarenotamendabletoballoonsandwherethephysiciandoesn’twanttoleaveinastentpermanently6869MultiplestentsStentinStenttechnique:SeveralstentsmightbeneededtocovertheneckareaSomephysicianswillputstents‘ineachother’tomaketheirown‘flowdiversion’productX–orY-stenting:Asecondstentisbroughtinthroughthefirststentanddeployed.KissingTechnique:Thestentsaredeployednexttoeachother6970StentingTechniques7071StentingTechniques*Fieldexperience7172Y-StentingOnestentisputinanddeployed.Asecondstentisbroughtinthroughthefirststentanddeployed.7273KissingTechniquewithStraightStentFirstInsteadofbringinginanotherstentthroughthestent,thestentsaredeployednexttoeachother.7374KissingTechniquewithBranchStentFirstInbothcases,thefirststentdidnotmovewhenthesecondstentwasdeployed.74MedicalTherapyLOREMIPSUMDOLOR7576Pre-procedureElectiveDailydoses,starting3-4dayspriortoprocedure,wanttoloadthepatientwithanti-platelets:Aspirin:325–1,300mgPlavix:75mgAspirin:Takes2–4hourstoalterplateletfunctionReducesriskofvascularmortalityPlavix:Takes2daystoalterplateletfunction7677Pre-procedureEmergencyRightbeforeprocedure:Aspirin:325-1300mgPlavix:300–600mgDisadvantageofgivingPlavixshortlybeforeprocedureisthatitisnotaseffectiveforplateletblockage50%ofplateletsblockedin3-4hrs7778Post-procedureAfterprocedurecontinuePlavix(75mg)andaspirin(325mg)for30–90days.Then:Stopboth(notverycommon)orStopPlavixandcontinueaspirinat325mgor81mg(babyaspirin)forlife(mostcommon)78TipsandTricksLOREMIPSUMDOLOR7980TipsandTricksCoilingWhenthecatheterisjailed,keepingthestentattachedduringcatheterremovalwillgiveadditionalstability.Keepingthestentattacheduntiltheendoftheprocedure,preservestheoptiontoretrieve/repositionifthecoilsdon’tsitwell.Stentworksverywellforbifurcation,asyoucanputastentthroughthestruts.Alsonott&tTheabilitytoretrieve/repositiongivesincrediblepeaceofmind!(thisispositioningnottipandtricks)8081TipsandTricksDeliveryRebaristhepreferredmicrocatheter.Thestentdeliversbestthroughit.IfyougetaRebarinposition,thestentwillfollow.Why?UseRebarwithonlyonemarker…Afterputtingstentthroughthehub,flushthemicrocatheterbeforebringinginthestent.ShouldhavecontinuousflushgoingFormostaccuratepositioning,movethestentminimumof2markerlengthsdistalpasttheAN.Thiswillbeapp.4mm.8182TipsandTricksDetachmentToavoidaccidentalprematuredetachment,keepdetachmentzonecoveredwiththemicrocatheteruntilyouarereadytodetach.Whendetachingthestent,exposedetachmentzonebyunsheathingthecatheter.Keepmicrocatheter1-2mmproximaltothedetachmentzonetoavoidlongerdetachmenttimesorafalsepositive.82ClinicalLOREMIPSUMDOLOR8384ClinicalPapersANovelSelf-ExpandingFullyRetrievableIntracranialStent(SOLO):ExperienceinNineProceduresofStent-assistedAneurysmCoilOcclusion–ThomasLiebig,HansHenkes,J?rgReinartz,ElinaMiloslavski,andDietmarKühne–Neuroradiology2006:48:471-478Immediateandmidtermfollow-upresultsofusinganelectrodetachable,fullyretrievableSOLOstentsystemintheendovascularcoilocclusionofwide-neckedcerbralaneurysms–KivilcimYavuz,M.D.,SerdarGeyik,M.D.,AlmilaGulsunPamuk,M.D.,OsmanKoc,M.D.,IsilSaatci,M.D.,andH.SaruhanCekirge,M.D.–JNeurosurg107:1–7,200784競爭產(chǎn)品LOREMIPSUMDOLOR85優(yōu)點(diǎn)網(wǎng)眼大Ystent技術(shù)操作簡單可回收可應(yīng)用于更廣泛的血管直徑支架重疊，類似“FD”效果網(wǎng)眼大彈簧圈調(diào)出，范圍3mm?868687產(chǎn)品信息縱覽8788StentImagesSolitaireNeuroform&WingspanaresameBUTWingspanhashigherradialforceLeoPlusEnterprise8889RadialForce8990RadialForcePhysicianswouldliketoseecomparisondata,thenumbersdon’treallytellthemanythingClinicalimportance:MeasureformigrationandstabilityAhigherradialforcesignalsthatstentmightgrabthevesselwallbetteranddoesn’tmigrateComparison:Enterprise,SolitaireandWingspanhavealmostsameradialforce,soSolitaireisok.9091Metaltovesselratio9192Conformability9293ConformabilityPhysiciansdon’tcommonlyaskforthisdata:EnterpriseisconsideredgoodComparison:EnterpriseisfineandSolitaireissignificantlybetter9394WallAppositionSolitaireEnterpriseLeoNeuroformStentsdeployedin3mmvessel,2.4mmbendradius9495WallAppositionSolitaireEnterpriseLeoNeuroformStentsdeployedin4mmvessel,2.4mmbendradius9596WallAppositionImportantdataforthephysicians.Clinicalimportance:Cellsofstentsthatdon’thaveagoodwallapposition,can’texpandthatwellandthiscanhaveaneffectongettingthecatheterthru->willhavetojailthecatheterPotentialofcoilherniationComparison:SolitaireABmaintainsbetterwallappositionthanEnterpriseandNeuroform9697Gator-BackingNeuroform33.5x20Leo3.5x25SolitaireAB4x20Enterprise4.5x22Wingspan3.5x159798KinkingSolitaireAB4x20Enterprise4.5x22Leo3.5x25Neuroform33.5x20Wingspan3.5x159899Gator-BackingandKinkingForsomephysiciansthisisimportant,forothersitis‘nice-to-know’thoughwouldn’tstopthemfromusingastenttheylike.Clinicalrelevance:MayresultincoilherniationUnlikelythatkinkingwillresultinvesselocclusion,thoughitmightlimitcatheteraccessComparison:Gator-backingandkinkingnotobservedinSolitaireABandEnterprise99100StentCellArea100101StentCellSize101102CellareaandsizePhysicianswouldliketoknowbothdataClinicalrelevance:WanttoknowwholeareaforpotentialcoilherniationThesizeisimportantforcathetersizetobeabletogothruComparison:Abletoplacea3mmstentthroughSolitaireABforbifurcation/Y-stenting,whileotherstentshavemuchsmallercellsizeAcatheterdiameterof3mmcancrossSolitaire,whileacatheterdiameterof1.3mmcancrosstheEnterprise.ThelargestcatheterthatcanpassthroughinSolitaireis8F.Thisislargerthanmostdevicesusedinneurovascularintervention.SolitaireABcelllengthissimilartoEnterprise,thoughSolitaireistwiceaswide,thereforecellareaofSolitaireistwiceaslarge.102103WorkingareaforeshorteningWorkingareaofSolitaireABdoesnotforeshorten103104DeliverymethodSolitaireAB:Deviceattachedtopushwire,loadedintoasheath.Pushedthroughentirecatheter.Electrolyticdetachment.Enterprise:Deviceisloadedintoasheath,loadedovertheguidewireandpushedthroughtheentirecatheter.Deviceisreleasedfromtheguidewirewhenreleasedfromthecatheter.NeuroformandWingspan:Deviceloadedoverpolymertubeandpreloadedattipofcatheter.Guidewireaccessthroughpolymertube.Deviceisreleasedwhencatheterispulledback.Leo:Devicehookedontopushwire,loadedintoasheath.Pushedthroughentirecatheter.Devicedetacheswhenpushwiretipexitscatheterandunhooksfromdevice.104105DeliverymethodClinicalrelevance:SolitaireABiseasytouse,deliverslikeacoil,noextrastepsneeded.Disadvantageispotentiallossofguidewireaccess.StentneedstobeabletobedeliveredattherightplaceComparison:Physicianswillchoosestentsbasedonaneurysmsizeandlocation,stentanddeliverycharacteristics.ItisimportanttounderstandofyourphysicianwhathetakesintoconfigurationandhowSolitairewillworkinhispractice.105MarketOverviewLOREMIPSUMDOLOR106107ProjectedMarketsize107108EstimatedMarketOverview108109OutlookSolitaireABPotentialrisks:ProductavailabilityFullrangeofsizesFlowDiversion109StentsandBalloonsLOREMIPSUMDOLOR110111StentsAdvantagesStraightforwardandeasyprocedureSmallriskofcoilherniationChoicebetweencoilingthruthestrutsorjailingthecatheter.CanputstentinafewdaysbeforecoilingandletitendothelializeIfalooppopsout,youonlyhavetopulloutthatspecificcoil111112StentsDisadvantagesPermanentforeignbodyinthebrain,nolong-termresultsavailableyetNeedlife-timemedicationtominimizein-stentrestenosisorthrombosisStentcanjumpDifficultydeployingthestentintortuousenvironmentSeveralstentsmightbenecessarytocovertheneck(stentinstenttechnique)Safety:Riskofcatheterstuckinstent112113BalloonsAdvantagesPreventsmisplacementofcoilsandreducesriskofischemiceventsAfterprocedurenoforeignmaterialremainsinvesselSafety:NoneedtoplacecatheterdeepinANforcoildeliveryIncaseofrupture,aplacedballoonallowsforimmediatehemorrhagecontrolAllowscoverageofcomplexanddifficultlocatedwideneckaneurysmsUsuallynomedsneeded(eventhoughsomephysiciansprefertogivePlavixand/oraspirin)113114BalloonsAssistedCoiling–HyperGlide/HyperFormDisadvantagesNopermanentbarrierProcedureincreasesincomplexityanddurationTrainingrequiredNeedtocontroltheinflationanddeflationInstability,ballooncanjumpBloodcanre-entertheAN,increasingthepressureandleadingtopotentialANrupturingCanonlyseeafterballoonhasbeenremovedandallcoilsdelivered,ifalooppopsout.Ifsoallcoilswillhavetobepulledout.114115StrategicImplicationsIt’snot(necessarily)aneither/orstoryStentorBallooncanbeusedinmostcasesEngagethediscussionwithyourphysician!HighlightbenefitsofbothandhowtheycanworkcomplementaryACOMM:rarelytreatedw/oballoonPCOMM:balloonandstentworkwell115116KeyMessages“Fullydeployable.Completelyretrievable.”EaseindeliveryAccuracyanddeploymentcontrolOptimalcoilmasssupportElectrolyticdetachment116117SalesToolsAvailableQ1:BrochureCompetitiveoverviewIn-servicepresentationCasestudybookletWebsiteTargetedinQ2:WallchartCDwithvideoonpreparation,deploymentanddetachmentSalesContestBoothgraphics117118