肾动脉支架植入术图文详解
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PTRA. • PTRA does not cure Essential Hypertension
Renal Insufficiency
• Nephrosclerosis after RAS or occlusion • PTRA is indicated to reverse or prevent the
Aim of the treatment
1) Renovascular Hypertension 2) Renal Insufficiency
Renovascular Hypertension
• 5% of all hypertensive patients • Due to atherosclerosis or FMD • Diagnosed after Surgical follow-up or
Gold standard treatment today…
• Medical treatment
– ACE inhibitors and a new class of Angiotensin receptor blockers
Endovascular Options: PTA or Stenting ?
decline of kidney functions • 8cm long kidney is the lower limit after
which kidney function might be compromised
Indications for PTRA
• Failed medical therapy • Reducing drug treatment • Pressure gradient >10% • More than 50% stenosis • Assymmetrical loss of renal mass
Restenosis after stenting
• Recent studies have indicated rates are between 10-20% (much better than the 30% with just PTA).
Treatment Options
• Medical Treatment • PTA with Stenting • Surgery • Dialysis: Renal Function never get better
dilatation (stenting if necessary)
3) Treatment FMD
dilatation (stenting if necessary)
Post-ostial lesion
Fibro-Muscular Dysplasia
Fibro-Muscular Dysplasia
Endovascular Treatment of Renal Artery Stenoses
1) Treatment of artheriosclerotic ostial lesions
(80%)
dilatation + stenting
2) Treatment of post ostial lesions
• 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion
Number of patients
PTA Stenting
42
43
Primary patency rate
29% 75%
Primary success rate
1) Through the groin using 8F materials
• 035’ • Radiologist who are used to
traditional PTA balloons, • More range in PTA balloons • Balloons: P3, Opta Pro • Stents: Genesis premounted
on OPTA -PRO • Wire 035, Jindo, Storq • 8F Vista brite Tip or IG
57% 88%
Restenosis post-procedure 48% 14%
Literature…
Hale Waihona Puke Baidu
Product Strategies
• 014” • Cardiologist, Radiologists,
Vasc Surgeons. • Balloon: M3 Rx • Stents: Corinthian IQ on M3 • Wire, Stabilizer • 7-8F Vista Brite Tip or IG
A new approach: .018 !
A GOOD COMPROMISE ! • Radiologist who are used to traditional PTA
balloons, • More range in PTA balloons • Balloons: Slalom • Stent: Genesis premounted on OPTA -PRO • Wire 018, SV • 6-7F Vista brite Tip or IG
Endovascular Treatment of Renal Artery Stenosis
Clinical Indications
(Procedures)
Anatomy
Kidney anatomy
Endovascular Treatment of Renal Artery Stenoses
Advantages of .014 systems
Less spasm with .014 wire Less wire length Smaller puncture site Stent protected by GC Good support
Endovascular Treatment of Renal Artery Stenoses
Renal Insufficiency
• Nephrosclerosis after RAS or occlusion • PTRA is indicated to reverse or prevent the
Aim of the treatment
1) Renovascular Hypertension 2) Renal Insufficiency
Renovascular Hypertension
• 5% of all hypertensive patients • Due to atherosclerosis or FMD • Diagnosed after Surgical follow-up or
Gold standard treatment today…
• Medical treatment
– ACE inhibitors and a new class of Angiotensin receptor blockers
Endovascular Options: PTA or Stenting ?
decline of kidney functions • 8cm long kidney is the lower limit after
which kidney function might be compromised
Indications for PTRA
• Failed medical therapy • Reducing drug treatment • Pressure gradient >10% • More than 50% stenosis • Assymmetrical loss of renal mass
Restenosis after stenting
• Recent studies have indicated rates are between 10-20% (much better than the 30% with just PTA).
Treatment Options
• Medical Treatment • PTA with Stenting • Surgery • Dialysis: Renal Function never get better
dilatation (stenting if necessary)
3) Treatment FMD
dilatation (stenting if necessary)
Post-ostial lesion
Fibro-Muscular Dysplasia
Fibro-Muscular Dysplasia
Endovascular Treatment of Renal Artery Stenoses
1) Treatment of artheriosclerotic ostial lesions
(80%)
dilatation + stenting
2) Treatment of post ostial lesions
• 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion
Number of patients
PTA Stenting
42
43
Primary patency rate
29% 75%
Primary success rate
1) Through the groin using 8F materials
• 035’ • Radiologist who are used to
traditional PTA balloons, • More range in PTA balloons • Balloons: P3, Opta Pro • Stents: Genesis premounted
on OPTA -PRO • Wire 035, Jindo, Storq • 8F Vista brite Tip or IG
57% 88%
Restenosis post-procedure 48% 14%
Literature…
Hale Waihona Puke Baidu
Product Strategies
• 014” • Cardiologist, Radiologists,
Vasc Surgeons. • Balloon: M3 Rx • Stents: Corinthian IQ on M3 • Wire, Stabilizer • 7-8F Vista Brite Tip or IG
A new approach: .018 !
A GOOD COMPROMISE ! • Radiologist who are used to traditional PTA
balloons, • More range in PTA balloons • Balloons: Slalom • Stent: Genesis premounted on OPTA -PRO • Wire 018, SV • 6-7F Vista brite Tip or IG
Endovascular Treatment of Renal Artery Stenosis
Clinical Indications
(Procedures)
Anatomy
Kidney anatomy
Endovascular Treatment of Renal Artery Stenoses
Advantages of .014 systems
Less spasm with .014 wire Less wire length Smaller puncture site Stent protected by GC Good support
Endovascular Treatment of Renal Artery Stenoses