波科外周Guidewires中文导丝.ppt

1、Peripheral Guide Wires:外周介入导丝：Standard, Hydrophilic & Specialty标准，亲水性 & 特殊,This document is intended for internal educational purposes only and shall not be distributed outside of Boston Scientific.,PI Guide WiresOverview,Purposes of a guide wire:导丝的作用：Gain access into vessels 到达目标血管Deliver devices

2、输送手术器械Cross lesions 穿越病变部位Used in vascular and non-vascular procedures可用于血管和非血管介入手术Used in all diagnostic and therapeutic procedures可用于所有的诊断和治疗介入手术The Backbone of every procedure 每例介入手术均需使用,PI Guide WiresGeneral Features & Intended Benefits,PI Guide Wires General Components外周介入导丝的一般结构,Core Wire: Usu

3、ally Stainless Steel or Nitinol导丝轴芯：通常为不锈钢和镍钛诺合金,Distal Tip: Working end of wire; comes in multiple shapes: straight, angled, shapeable, J远端头端：导丝的工作端；有多种形状：直型，成角型，可塑性，J型,Lubricious Coating: PTFE, Silicone, or Hydrophilic光滑涂层：PTFE，硅，或亲水性,Distal Tip远端,Safety Ribbon安全带,Core wire轴芯,Coil wire螺旋金属丝,Proxim

4、al End近端,Floppy/Light Support (POBA): Starter Guide Wire松软型/轻度支撑（POBA）：StarterTM 导丝Most flexible; least rail support 最佳的柔韧性；最小的支撑力Less likely to cause vessel damage 最小的血管损伤Moderate Support (Stent): Magic Torque Guide Wire中度支撑（支架）： Magic Torque 导丝Rail support between Floppy & Extra Support 介于松软型 & 超硬

5、导丝之间Added support for stent delivery 为放置支架提供额外的支撑Extra Support (Stent): Amplatz Guide Wire额外支撑（支架）： Amplatz 导丝Long rail support region, but soft tip 杆身支撑力更强，柔软的头端Designed for first generation stent delivery 设计用于放置第一代的支架,PI Guide WiresCore Wire Flexibility & Support轴芯 柔韧性 & 支撑力,Diameters most commonl

6、y used in interventions:在介入手术中最常使用的导丝直径：.014” - Coronary and small vessel balloons - 冠状动脉和小血管球囊.018” - Renal and small vessel balloons - 肾动脉和小血管球囊.035” - Balloons and catheters, “workhorse” - 球囊和导管，“使用最普遍”.038” - Large devices requiring extra support (rarely used) - 需要额外支撑的较大器械（很少使用）Other less commo

7、n diameters are .032” and .025” 其他较少使用的直径： .032” 和 .025”Trend towards smaller diameters (.014”) 趋向于小直径导丝（.014”）Common guide wire lengths:通常的导丝长度：75cm, 150cm, 180cm, 260cm, 300cm,PI Guide WiresSizing Diameters & Lengths尺寸 直径 & 长度,PI Guide WiresDistal Tip Configurations远端头端的类型,Tip Configurations:头端类型：

8、Straight, angled, J-Tip 直型，成角型， J型Non-hydrophilic, hydrophilic 非亲水性，亲水性Standard, floppy, stiff 标准型，松软型，硬型Tip taper 渐细的锥形头端,PI Guide WiresTypes for Gaining Initial Access,Bentson Guide Wire Straight, floppy, atraumatic tipJ-Tip Guide WireAtraumatic - use when worried about the potential for vessel pe

9、rforation. 无创伤 用于避免血管壁穿孔Starter Guide Wire Standard workhorseZIPwire Guide Wire Not indicated as a starter wire, but often used by physicians.,PI Guide WiresBSC Products,The three classifications of wires sold by Boston Scientific are:Standard Guide Wires 标准导丝Starter Guide Wire (includes Bentson, Ne

10、wton, & Rosen shapes)Hydrophilic Guide Wires 亲水性导丝ZIPwire Guide Wire (.18”, .025”, .035”, .038)Specialty Guide Wires 特殊导丝V-18 Control Wire Guide Wire (.018)Platinum PLUS Guide Wire (.014”, .018“, .025”)Thruway Guide Wire (.014 & .018)Magic Torque Guide Wire (.035)Amplatz Super Stiff Guide Wire (.035

11、“ & .038”)Meier Guide Wire (.035),PI Guide Wires BSC Product Positioning,Starter Guide Wires,The information included in this section is considered proprietary to Lake Region Manufacturing, Inc. Any copying, sharing and/or distributing is prohibited.,Starter Guide WireProduct Positioning,A family of

12、 ultra-smooth, PTFE guide wires.,Workhorse guide wire for routine procedures.,Starter Guide WireIndications,INTENDED USE: Starter guide wires are designed for percutaneous vessel entry using the Seldinger technique to facilitate subsequent introduction(s) of an intravascular device.,Starter Guide Wi

13、reProduct Specs,*Most are finger straightenable,Bentson, Newton, and Rosen are industry standard wire types sold by other companies as well.Available with or without heparin coating.Straight and J-tips available with fixed or moveable core (not available in all sizes).,Starter Guide WireFeatures & I

14、ntended Benefits,Starter Guide WireAreas of Clinical Use,Gaining access for routine procedures,Starter Guide WireKey Competitors,The following competitors also sell Bentson, Newton and Rosen wires, as well as other PTFE-coated competiting workhorse wires: Cook market leader in standard guide wires A

15、ngiodynamics Cordis St. Jude Bard Merit,Starter Guide WireKey Takeaways,Atraumatic, workhorse guide wire for routine procedures. Pre-Coat TechnologyDipped coating for excellent coating durability & consistency Finger straightenable J-tip Availability of heparin coating Moveable & fixed core options,

16、Sprayed Coating,Starter Guide Wire Dipped Coating (a.k.a. “Pre-Coat Technology”),GuidewiresConstruction - non hydrophilic wires,Starter Guidewire Fixed Core,Ideal first wire to use before or after Introducer Sheath Insertion Atraumatic Floppy Tip provides safety, Well balanced body provides ample pu

17、shability and support for Catheter ExchangePrecoat technology allows for ease of Catheter ExchangeLarge Size Matrix covers majority of clinical requirements,Starter Guidewire Moveable Core,Ideal first wire to use before or after Introducer Sheath Insertion Moveable Core allows adjustment of the Flop

18、py Tip length meaning one wire can provide both safety and support Well balanced body provides ample pushability and support for Catheter ExchangePrecoat technology allows for ease of Catheter ExchangeLarge Size Matrix covers majority of clinical requirements,Starter Guidewire Newton,Ideal wire to u

19、se for accessing delicate vessels and crossing fragile lesions such asRenal, Dialysis Fistula, Subclavian, Fempop.Watch out 0.018” wires may be more suitableAlso ideal for navigation of heavily diseased Iliacs and Aortas.Very Atraumatic Floppy tip, body support does allow catheter exchange,Starter G

20、uidewire New Bentson,Ideal wire to use for accessing delicate vessels and crossing fragile lesions such asRenal, Dialysis Fistula, Subclavian, Fempop.Watch out 0.018” wires may be more suitableAlso ideal for navigation of heavily diseased Iliacs and Aortas.Very Atraumatic Tip, less support than Newt

21、on means that catheter exchange may be limited,Starter Guidewire Rosen Heavy Duty,Ideal wire to use for catheter access where additional support is required especially in Ostial lesions due to short taper preventing flip outRenal, Dialysis Fistula, Subclavian, Fempop.Watch out 0.018” wires may be mo

22、re suitable,ZIPwire Hydrophilic Guide Wires ZIPwire 亲水性导丝,ZIPwire Guide Wire,ZIPwire Guide Wire产品定位,A family of hydrophilic guide wires designed for smooth passage through tortuous anatomy.设计用于流畅的通过迂曲的解剖结构,ZIPwire Guide Wire适应症,INDICATIONS: The ZIPwire Hydrophilic Guide Wire is intended to facilitat

23、e the placement of devices during diagnostic and interventional procedures.ZIPwire 亲水性导丝用于在诊断性和治疗性介入手术中协助置入器械。,ZIPwire Guide Wire产品技术参数,ZIPwire is a trademark of Boston Scientific Corporation or its affiliates. Glidewire is a trademark of Terumo Corporation.,Note: See Guide Wires brochure or price b

24、ook for all available combinations.注意：请参见相关产品彩页或手册了解所有的产品型号,ZIPwire Guide WireEnhanced Manufacturing Process,A polymer jacket is extruded over a kink-resistant nitinol core. 聚合物外壳覆盖在抗扭曲的镍钛诺合金轴芯表面Hydrophilic coating is bonded to the polymer jacket.亲水性涂层粘合在聚合物外壳上,Radiopaque Polyurethane Jacket 不透X线的聚亚

25、安酯外壳,Nitinol Core镍钛诺轴芯,Hydrophilic Polymer Coating亲水性聚合物涂层,The manufacturing process enhancements treated the surface of the polyurethane jacket for consistent adhesion of the hydrophilic coating.,ZIPwire Properties,Kink-resistant抗扭曲性The nitinol metal alloy core provides the strength necessary to ma

26、ke the ZIPwire guidewire kink-resistant. 镍钛诺合金材质的导丝轴芯使ZIPwire导丝具有良好的抗扭曲性能。Steerable操控性Single piece construction and atraumatic tip allow excellent steerability. 一体式结构和无创性头端使其具有优异的操控性。The unique alloy core and polyurethane jacket of the ZIPwire guidewire provide a true 1:1 torque response. 独特的合金轴芯和聚亚

27、安酯外壳实现了1:1扭控反应。Frictionless光滑度The hydrophilic coating makes the ZIPwire guidewire virtually frictionless when wet. The ZIPwire guidewire slides easily into place and smoothly guides catheters. 亲水性涂层在水化后变得非常光滑，易于到达病变部位和推送导管。,ZIPwire Properties,Low Thrombogenicity (tendency to produce blood clots)低血栓性

28、（产生凝血块的趋势）The frictionless coating results in low potential for the formation of blood clots on the surface of the ZIPwire guidewire. 光滑的亲水涂层有效减少了在导丝表面形成血凝块的危险。Radiopaque显影性The polyurethane is impregnated with tungsten, a radiopacifier for enhanced visibility. 聚亚安酯外壳中含有钨，在X线下具有良好的可视性。Atraumatic无创性Th

29、e various cores result in soft, flexible tip configurations. 不同的轴芯 各种类型的柔软而富有弹性的头端。,ZIPwire Guide WireFeatures & Intended Benefits,ZIPwire Guide Wire临床应用领域,Aortic bifurcation area腹主动脉分叉,Carotids颈动脉,HAM血透通路,Crossing CTOs通过完全阻塞的病变Subintimal Angioplasty内膜下血管成形术,ZIPwire Guide WireKey Competitors,Glidewi

30、re Guide Wire (Terumo - previously sold by Boston Scientific)- Hydrophilic market leaderRoadrunner Guide Wire (Cook)AQUALiner Guide Wire (Angiodynamics)HiWire Guide Wire (Cook)HydroSteer Guide Wire (St. Jude Medical),ZIPwire Guide WireKey Takeaways,The ZIPwire Guide Wire is a hydrophilic guide wire

31、designed for maneuvering through tortuous anatomy.ZIPwire 亲水性导丝设计用于通过迂曲的解剖结构。 Precise 1:1 torque response 精确的1:1扭控反应 Highly radiopaque jacket 高显影性外壳 Comprehensive selection of shafts, lengths, and tips 有多种不同硬度、长度和头端类型的型号,Amplatz Super Stiff Guide Wire Amplatz Super Stiff 超硬导丝,Amplatz Super Stiff Gui

32、de Wire 产品定位,A stiff, secondary (non-starter) wire when strength and stability are required for catheter placement and exchange.硬度更高，具有更高的强度和稳定性，用于放置和更换导管。,Amplatz Super Stiff Guide Wire 适应症,INDICATIONS:The Amplatz Super Stiff Guide Wire facilitates catheter placement and exchange during diagnostic

33、or interventional procedures. It is not intended for use in coronary arteries.Amplatz Super Stiff超硬导丝用于在诊断性和治疗性介入手术中放置和更换导管。不适用于冠脉手术。,Amplatz Super Stiff Guide Wire 产品技术参数,Note: See Guide Wire brochure or price book for all available combinations.注意：请参见相关产品彩页或手册了解所有的产品型号,Amplatz Super Stiff Guide Wi

34、reFeatures & Intended Benefits,Amplatz Super Stiff Guide Wire临床应用领域,Aortic bifurcation area主动脉分叉,Carotid/aortic arch area颈动脉/主动脉弓,Amplatz Super Stiff Guide WireKey Competitors,“Amplatz” is a standard wire name sold by other companies including Cook and Cordis. Others competing wires include: Wholey

35、HI-TORQUE (Covidien) HI-TORQUE Supra Core (Abbott Vascular),Amplatz Super Stiff Guide WireKey Takeaways,Very supportive wire 具有高支撑力For secondary use (not for gaining initial access) 第二根导丝（不作为进入导丝）Strong enough to get through tight lesions, yet tip is soft enough for reduced trauma during advancement

36、. 具有足够的强度通过狭窄病变，同时柔软的头端可避免在推进导丝时损伤血管。,Amplatz Super Stiff Guidewire,Super stiff wire body with an atraumatic tip for catheter placement and exchange in uroradiology, biliary drainage, abscess drainage and vascular procedures. 具有良好硬度的杆身和无创性头端，可用于在泌尿系统、胆道引流、脓肿引流和血管介入手术中放置和更换导管。PTFE Coating helps to re

37、duce friction and allows for easy catheter passage PTFE涂层减少了摩擦力，便于推进导管。,在具有出色的硬度、强度、稳定性的同时柔软的无创伤头端有良好的安全性,Magic Torque Guide Wire,Magic Torque Guide Wire Product Positioning,.035,3CM,50CM,GLIDEX,180 / 260CM,Excellent torque control and radiopaque Magic Markers for enhanced visualization to meet the

38、challenges of difficult anatomy.,Magic Torque Guide Wire Indications,INDICATIONS:The Magic Torque Guide Wire facilitates placement of a catheter during diagnostic or interventional procedures. The wire can be torqued to facilitate navigation through tortuous arteries and/or avoid unwanted side branc

39、hes.,Magic Torque Guide Wire Product Specs,Magic Torque Guide Wire Features & Intended Benefits,.035,3CM,50CM,GLIDEX,180 / 260CM,Magic Torque Guide Wire Areas of Clinical Use,.035,3CM,50CM,GLIDEX,180 / 260CM,Aortic bifurcation area,Carotid/aortic arch area,SFA/BTK,Magic Torque Guide Wire Key Competi

40、tors,The Graduate Measuring Wire (Cook) Wholey-HI-TORQUE Guide Wire (Covidien) HI-TORQUE Supra Core Guide Wire (Abbott Vascular),Precise 1:1 torque responseRadiopaque “Magic Markers” allow for accurate measurement visualization,Magic Torque Guide Wire Key Takeaways,Magic TorqueGlidex Coated Hydrophi

41、lic Guidewire,Combining 4 distal platinum Magic markers with Glidex hydrophilic coating and an excellent torque control*.Great for navigating tortuous anatomy and accessing side branches.Support is great for delivering Stent / Balloon CathetersMarkers make correct stent sizing easy and avoid any par

42、allax effect,Meier Wire (Backup Meier),Meier Guide Wire Product Positioning,.035,3CM,50CM,GLIDEX,180 / 260CM,First guide wire indicated for AAA endovascular graft procedures. Stiff shaft provides excellent support, while flexible tip reduces the risk of vessel trauma.,Meier Guide Wire Indications,IN

43、DICATIONS:The Back-Up Meier Steerable Guide Wire facilitates catheter placement and exchange during diagnostic or interventional procedures including AAA endovascular graft procedures.,Meier Guide Wire Product Specs,.035,3CM,50CM,GLIDEX,180 / 260CM,Meier Guide Wire Features & Intended Benefits,.035,

44、3CM,50CM,GLIDEX,180 / 260CM,Meier Guide Wire Areas of Clinical Use,GLIDEX,AAA,Meier Guide Wire Key Competitors,Cook Lunderquist Extra Stiff Guide Wire Also referred to as the “coat hanger”,Very supportive wire for AAA procedures.Highly radiopaque gold-plated tungsten spring coil tip is designed to e

45、nhance visualization for more accurate placement.,Meier Guide Wire Key Takeaways,Back-up Meier Steerable Guidewire,Balancing the support, flexibility and radiopacity required for efficient catheter placement,Optimally stiff stainless steel shaft coreStraightens tortuous anatomyProvides the “railroad

46、 tracks” for large device to followVery flexible and soft distal tip (J or C tip construction)A soft and flexible tip minimizes the risk of perforating the aortic arch or causing other vessel trauma (dissection)Minimizes the risk of dislodging thrombus from the aorta Highly radiopaque gold-plated tu

47、ngsten spring coil tipProvides excellent visibility of the wire under fluoroscopy for accurate placementPTFE coated proximal shaftPromotes smooth catheter advancementReduces the risk of thrombus formationLarge device easily tracks on PTFE shaft,Platinum PLUS Guide Wire,Platinum PLUS Guide WireProduc

48、t Positioning,.035,3CM,50CM,180 / 260CM,For negotiation of tortuous anatomy and contralateral approaches including smaller vessels (.014” & .018”) and those with short distal purchase (short taper).,Platinum PLUS Guide WireIndications,.035,3CM,50CM,GLIDEX,180 / 260CM,INDICATIONS:The Platinum PLUS guide wire facilitates placement of a catheter during diagnostic or interventional intravascular procedures. The wire can be torqued to facilitate navigation through tortuous arteries and/or avoid unwanted side branches.,