Lựa chọn ống thông can thiệp mẹo để hỗ trợ can thiệp và giảm biến chứng

Lựa chọn ống thông can thiệp: Mẹo để hỗ trợ can thiệp giảm biến chứng PGS TS Hồ Thượng Dũng, FSCAI BV Thống Nhất, TP HCM HÀ NỘI- 10/ 2016 • Chọn lựa ống thơng can thiệp chìa khóa giúp mở cánh cửa thành cơng can thiệp mạch vành 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Chức đặc điểm Ống thông can thiỆp Chức ống thống can thiệp • Conduit for transporting guide wire & devices Polymer Blend Back up support Curve retention Shaft stiffness • Mode for injecting contrast • Platform for back up support during intervention • Mechanism for measuring aortic & arterial pressures Wire Braid Inner Liner Kink resistance Torque response Shaft radiopacity Device Passage 070” 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Ống thông can thiệp so với Ống thông chẩn đốn • Stiffer shaft • Larger internal diameter (ID) • Shorter & more angulated tip • Re-enforced construction • (3 vs layers) • Tip Non Tapered • Tip May be Soft or Radiopaque 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Các đặc tính quan trọng cần thiết Ống thông can thiệp Many Principles similar but some variations in size and catheter types to accommodate various devices • Atraumatic tip • Proper preformed shape ( co-axial with vessel) • Access site • Active vs Passive Support • Torque control • Kink resistance • Radiopacity 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Cấu tạo cấu trúc Ống thông can thiỆp Cấu tạo- cấu trúc ống thông can thiệp Overall stiffness 6/20/2016 Torque Generation Smooth passage delivery of devices Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Lòng ống thơng can thiệp lớn Advantage Disadvantages • Better opacification of the contrast • Better guide support • Allow pressure monitoring • Allow special devices and technique • Ostia trauma • Vascular complication • Possible kinking of cath shaft • Rotablator • Kissing balloons • Kissing stents 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Curve/Tip Length S Judkins Left 4.0 3.0 5.0 P Tip Length = P to S distance (cm) P = Primary Curve S = Secondary Curve 6/20/2016 Sources: Diagnostic and Therapeutic Cardiac Catheterization; Grossman’s Cardiac Catheterization, Angiography, and Intervention Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 10 Guide Extension Clinical Uses • Deep seating for added back-up support • Coaxial guide alignment • Selective distal contrast delivery • Protected distal stent delivery 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 56 Mother Child Support with Guideliner Guide catheter distal tip GuideLiner distal tip 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 57 Distal Stent Delivery Guide Catheter tip Stent GuideLiner 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 58 Anchoring techniques: 2nd wire (Ironman) in branch proximal to CTO 3rd wire (Ironman) in branch 2.0 Balloon inflated in branch (coating wiped off) 6/20/2016 59 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Antegrade Anchoring 1.5 balloon 1.5 balloon 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 60 CTO of RCA Antegrade Anchoring 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 61 What to Watch Out for • Dissection from tip entry • Hydraulic dissection • Wire behind Liner • Wire wrap on hypotube • Kinking of catheter when “overextended” • Shearing wire on collar 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 62 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 63 When all else fails When All else fails • Start over • Trust you wire skills • Be persistent • Get help 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 64 Do You have Everything? 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 65 You can’t have everything • You can't always get what you want • But if you try sometimes well you just might find • You get what you need RICHARDS, KEITH / JAGGER, MICK 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 66 Summary & Conclusions • Guide catheter selection is a key to procedure success • Catheter construction and design offer important benefits • Guide catheter selection depends on access approach, anatomy, lesion location and morphology 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 67 Principle ■ Honing/Practising of catheter skills is crucial to coping with challenging anatomy ■ We need to select our own catheter series (our familiar catheter series) that works for us and perfect our manipulative skills (practice makes perfect) ■ One size does not fit all 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 68 Principle • Varying guide sizes can offer increased active or passive support • Guide extenders increase support – particularly when deap seated • Buddy wire and anchor techniques can make substantial impacts 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 69 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN 70 ...• Chọn lựa ống thơng can thiệp chìa khóa giúp mở cánh cửa thành công can thiệp mạch vành 6/20/2016 Ho Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Chức đặc điểm Ống thông can thiỆp... Dung, Thong Nhat hospital, Hochiminh city, VN 10 Đặc điểm chế hoạt động MỘT SỐ Ống thông can thiỆp Chọn lựa ống thơng can thiệp Variable Requirements • Aorta Size • Co-axial intubation • Location... Thuong Dung, Thong Nhat hospital, Hochiminh city, VN Cấu tạo cấu trúc Ống thông can thiỆp Cấu tạo- cấu trúc ống thông can thiệp Overall stiffness 6/20/2016 Torque Generation Smooth passage delivery