肾动脉支架植入术图文详解
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Endovascular Treatment of Renal Artery Stenosis
Clinical Indications
(Procedures)
Anatomy
Kidney anatomy
Endovascular Treatment of Renal Artery Stenoses
Brite Tip Sheath 6F 90cm + RDC Tempo 4F +.014 Stabilizer
BTS 6F 90cm +.014 Stabilizer
BTS 6F 90cm +.014 Stabilizer + M3
BTS 6F 90cm +.014 Stabilizer + M3
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
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
Gold standard treatment today…
• Medical treatment
– ACE inhibitors and a new class of Angiotensin receptor blockers
Endovascular Options: PTA or Stenting ?
Endovascular Treatment of Renal Artery Stenoses
Procedural
Post procedure
Endovascular Treatment of Renal Artery Stenoses
Pre operative
Post operative
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
1) Through the groin using 8F materials
Can be downsized to 7F using M3
Emerald .035
Emerald .035 + Pigtail Tempo 4-5F 65cm
Emerald .035 + Renal Curve Tempo 4F 65cm
.014 Stabilizer + 6F BTS 55cm + M3
.014 Stabilizer + 6F BTS 55cm + M3
.014 Stabilizer + 6F BTS 55cm + Corinthian IQ on M3
.014 Stabilizer + 6F BTS 55cm + Corinthian IQ
57% 88%
Restenosis post-procedure 48% 14%
Literature…
Product Strategies
• 014” • Cardiologist, Radiologists,
Vasc Surgeons. • Balloon: M3 Rx • Stents: Corinthian IQ on M3 • Wire, Stabilizer • 7-8F Vista Brite Tip or IG
PTRA. • PTRA does not cure Essential Hypertension
Renal Insufficiency
• Nephrosclerosis after RAS or occlusion • PTRA is indicated to reverse or prevent the
Emerald .035 + Renal Curve Tempo 4F 65cm
Emerald .035 + RDC Vista Brite Tip 8F 55cm
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
• 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion
Number of patients
PTA Stent百度文库ng
42
43
Primary patency rate
29% 75%
Primary success rate
• 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
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
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
3) Through a brachial access
Tempo 4F MP + .014 Stabilizer
Brite Tip Sheath 6F 90cm + .014 Stabilizer
Brite Tip Sheath 6F 90cm + .014 Stabilizer
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
Emerald .035 + RDC VBT 8F 55cm
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
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
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 Stenoses
1) Treatment of artheriosclerotic ostial lesions
(80%)
dilatation + stenting
2) Treatment of post ostial lesions
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
Endovascular Treatment of Renal Artery Stenoses
2) Through the groin using the new 6F materials
.014 Stabilizer
.014 Stabilizer + 6F Brite Tip Sheath 55cm
Clinical Indications
(Procedures)
Anatomy
Kidney anatomy
Endovascular Treatment of Renal Artery Stenoses
Brite Tip Sheath 6F 90cm + RDC Tempo 4F +.014 Stabilizer
BTS 6F 90cm +.014 Stabilizer
BTS 6F 90cm +.014 Stabilizer + M3
BTS 6F 90cm +.014 Stabilizer + M3
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F
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
Gold standard treatment today…
• Medical treatment
– ACE inhibitors and a new class of Angiotensin receptor blockers
Endovascular Options: PTA or Stenting ?
Endovascular Treatment of Renal Artery Stenoses
Procedural
Post procedure
Endovascular Treatment of Renal Artery Stenoses
Pre operative
Post operative
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
1) Through the groin using 8F materials
Can be downsized to 7F using M3
Emerald .035
Emerald .035 + Pigtail Tempo 4-5F 65cm
Emerald .035 + Renal Curve Tempo 4F 65cm
.014 Stabilizer + 6F BTS 55cm + M3
.014 Stabilizer + 6F BTS 55cm + M3
.014 Stabilizer + 6F BTS 55cm + Corinthian IQ on M3
.014 Stabilizer + 6F BTS 55cm + Corinthian IQ
57% 88%
Restenosis post-procedure 48% 14%
Literature…
Product Strategies
• 014” • Cardiologist, Radiologists,
Vasc Surgeons. • Balloon: M3 Rx • Stents: Corinthian IQ on M3 • Wire, Stabilizer • 7-8F Vista Brite Tip or IG
PTRA. • PTRA does not cure Essential Hypertension
Renal Insufficiency
• Nephrosclerosis after RAS or occlusion • PTRA is indicated to reverse or prevent the
Emerald .035 + Renal Curve Tempo 4F 65cm
Emerald .035 + RDC Vista Brite Tip 8F 55cm
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
• 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion
Number of patients
PTA Stent百度文库ng
42
43
Primary patency rate
29% 75%
Primary success rate
• 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
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
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
3) Through a brachial access
Tempo 4F MP + .014 Stabilizer
Brite Tip Sheath 6F 90cm + .014 Stabilizer
Brite Tip Sheath 6F 90cm + .014 Stabilizer
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ
Emerald .035 + RDC VBT 8F 55cm + Opta Pro
Emerald .035 + RDC VBT 8F 55cm
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro
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
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 Stenoses
1) Treatment of artheriosclerotic ostial lesions
(80%)
dilatation + stenting
2) Treatment of post ostial lesions
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3
Endovascular Treatment of Renal Artery Stenoses
2) Through the groin using the new 6F materials
.014 Stabilizer
.014 Stabilizer + 6F Brite Tip Sheath 55cm