肾动脉支架植入术图文详解

EndovascularTreatmentofRenalArteryStenosisClinicalIndications(Procedures)AnatomyKidneyanatomyEndovascularTreatmentofRenalArteryStenosesAimofthetreatment1)RenovascularHypertension2)RenalInsufficiencyRenovascularHypertension•5%ofallhypertensivepatients•DuetoatherosclerosisorFMD•DiagnosedafterSurgicalfollow-uporPTRA.•PTRAdoesnotcureEssentialHypertensionRenalInsufficiency•NephrosclerosisafterRASorocclusion•PTRAisindicatedtoreverseorpreventthedeclineofkidneyfunctions•8cmlongkidneyisthelowerlimitafterwhichkidneyfunctionmightbecompromisedIndicationsforPTRA•Failedmedicaltherapy•Reducingdrugtreatment•Pressuregradient10%•Morethan50%stenosis•AssymmetricallossofrenalmassEndovascularTreatmentofRenalArteryStenoses1)Treatmentofartherioscleroticostiallesions(80%)dilatation+stenting2)Treatmentofpostostiallesionsdilatation(stentingifnecessary)3)TreatmentFMDdilatation(stentingifnecessary)Post-ostiallesionFibro-MuscularDysplasiaFibro-MuscularDysplasiaRestenosisafterstenting•Recentstudieshaveindicatedratesarebetween10-20%(muchbetterthanthe30%withjustPTA).TreatmentOptions•MedicalTreatment•PTAwithStenting•Surgery•Dialysis:RenalFunctionnevergetbetterGoldstandardtreatmenttoday…•Medicaltreatment–ACEinhibitorsandanewclassofAngiotensinreceptorblockersEndovascularOptions:PTAorStenting?•1999:PeterVandeVen,randomizedtrialPTAvsStentinginostiallesionPTAStentingNumberofpatients4243Primarypatencyrate29%75%Primarysuccessrate57%88%Restenosispost-procedure48%14%Literature…ProductStrategies•014”•Cardiologist,Radiologists,VascSurgeons.•Balloon:M3Rx•Stents:CorinthianIQonM3•Wire,Stabilizer•7-8FVistaBriteTiporIG•035’•RadiologistwhoareusedtotraditionalPTAballoons,•MorerangeinPTAballoons•Balloons:P3,OptaPro•Stents:GenesispremountedonOPTA-PRO•Wire035,Jindo,Storq•8FVistabriteTiporIGAnewapproach:.018!AGOODCOMPROMISE!•RadiologistwhoareusedtotraditionalPTAballoons,•MorerangeinPTAballoons•Balloons:Slalom•Stent:GenesispremountedonOPTA-PRO•Wire018,SV•6-7FVistabriteTiporIGAdvantagesof.014systemsLessspasmwith.014wireLesswirelengthSmallerpuncturesiteStentprotectedbyGCGoodsupportEndovascularTreatmentofRenalArteryStenoses1)Throughthegroinusing8FmaterialsCanbedownsizedto7FusingM3Emerald.035Emerald.035+PigtailTempo4-5F65cmEmerald.035+RenalCurveTempo4F65cmEmerald.035+RenalCurveTempo4F65cmEmerald.035+RDCVistaBriteTip8F55cmEmerald.035+RDCVBT8F55cm+OptaProEmerald.035+RDCVBT8F55cm+OptaProEmerald.035+RDCVBT8F55cm+OptaProEmerald.035+RDCVBT8F55cmEmerald.035+RDCVBT8F55cm+CorinthianIQonOptaProEmerald.035+RDCVBT8F55cm+CorinthianIQonOptaProEmerald.035+RDCVBT8F55cm+CorinthianIQonOptaProEmerald.035+RDCVBT8F55cm+CorinthianIQonOptaProEmerald.035+RDCVBT8F55cm+CorinthianIQEndovascularTreatmentofRenalArteryStenoses2)Throughthegroinusingthenew6Fmaterials.014Stabilizer.014Stabilizer+6FBriteTipSheath55cm.014Stabilizer+6FBTS55cm+RDCTempo4F.014Stabilizer+6FBTS55cm+RDCTempo4F.014Stabilizer+6FBTS55cm+RDCTempo4F.014Stabilizer+6FBTS55cm+RDCTempo4F.014Stabilizer+6FBTS55cm+M3.014Stabilizer+6FBTS55cm+M3.014Stabilizer+6FBTS55cm+CorinthianIQonM3.014Stabilizer+6FBTS55cm+CorinthianIQEndovascularTreatmentofRenalArteryStenoses3)ThroughabrachialaccessTempo4FMP+.014StabilizerBriteTipSheath6F90cm+.014StabilizerBriteTipSheath6F90cm+.014StabilizerBriteTipSheath6F90cm+RDCTempo4F+.014StabilizerBTS6F90cm+.014StabilizerBTS6F90cm+.014Stabilizer+M3BTS6F90cm+.014Stabilizer+M3BTS6F90cm+.014Stabilizer+CorinthianIQonM3BTS6F90cm+.014Stabilizer+CorinthianIQonM3BTS6F90cm+.014Stabilizer+CorinthianIQonM3EndovascularTreatmentofRenalArteryStenosesProceduralPostprocedureEndovascularTreatmentofRenalArteryStenosesPreoperativePostoperative