13-Xact-2009-6-1-10

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Carotid Certification Training,AP2929160 Rev.A 2/09,*,Company Confidential 2009 Abbott Laboratories,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Xact,颈动脉支架系统,产品培训,:,Xact,颈动脉支架系统,Special thanks to the Physician Executive Committee for content development,This material is part of a comprehensive training program.Consult the complete,Instructions for Use,for additional information.,This information is not a substitute for the independent care and assessment of a health care practitioner skilled in the device use or disease state.,Carotid Certification Training,AP2929160 Rev.A 2/09,2,Company Confidential 2009 Abbott Laboratories,Xact,支架产品概况,The,Xact,颈动脉支架系统是设计用于专门治疗颈动脉狭窄的支架系统,The,Xact,支架设计特点：,增加对病变覆盖,降低正常节段的金属覆盖率,为不同病变和解剖特点的颈动脉狭窄构提供治疗选择,与,Emboshield,栓子保护装置及,Barewire,导丝兼容,Xact,Stent Placement,Image courtesy of Rajesh Dave,M.D.,Carotid Certification Training,AP2929160 Rev.A 2/09,3,Company Confidential 2009 Abbott Laboratories,使用说明及适应证,Xact,颈动脉支架系统,+,雅培血栓保护装置治疗颈动脉剥脱术外科高危患者，改善狭窄管腔直径，预防中风,颈动脉狭窄位于颈总动脉起始部和颈内动脉颅内段之间,(,症状性狭窄,B,超或,DSA,提示狭窄率,50%,，或无症状性狭窄,B,超或,DSA,提示狭窄率,80%),靶病变的参照血管直径,4.8 mm-9.1 mm,Carotid Certification Training,AP2929160 Rev.A 2/09,4,Company Confidential 2009 Abbott Laboratories,使用说明,:,禁忌症,使用,Xact,颈动脉支架系统时要考虑到支架相关的禁忌症，包括以下方面，但不仅限于此,:,抗凝或抗血小板禁忌,血管严重迂曲，或血管解剖因素造成导引导管、动脉鞘、,EPD,、球囊扩张导管、或,EPD,回收导管无法到位,镍钛金属材料过敏,不可纠正的出血性疾病,颈总动脉开口狭窄,Carotid Certification Training,AP2929160 Rev.A 2/09,5,Company Confidential 2009 Abbott Laboratories,培训内容,培训将提供,Xact,颈动脉支架的特点及使用方面的知识,支架的设计特点,支架系统的构成及使用,支架的合理选择,系统的准备和支架释放步骤,注意事项,Carotid Certification Training,AP2929160 Rev.A 2/09,6,Company Confidential 2009 Abbott Laboratories,系统特点,:,The,Xact,颈动脉支架系统的独特设计特点，包括：,Xact,支架的设计特点，及这些特点为什么能稳定斑块,如何根据靶病变如何选择支架,Freestyle Technology,的,特点及如何保证精确释放,Carotid Certification Training,AP2929160 Rev.A 2/09,7,Company Confidential 2009 Abbott Laboratories,系统特点,Xact,颈动脉支架系统的独特设计特点,:,3,种支架长度，网孔大小可变，与靶血管直径逐渐变细匹配,支架有不同网孔密度：,高网孔密度增加对病变血管壁的覆盖率,低网孔密度减少正常节段血管壁的覆盖率,闭环设计,Image courtesy of,newMentor,Carotid Certification Training,AP2929160 Rev.A 2/09,8,Company Confidential 2009 Abbott Laboratories,系统特点,Xact,颈动脉支架为各节点均连接的闭环设计。这可以：,增加对病变的覆盖率，减少对斑块的挤压,增加支架于其他介入设备的兼容性,Closed Cell Design,Image courtesy of,newMentor,Carotid Certification Training,AP2929160 Rev.A 2/09,9,Company Confidential 2009 Abbott Laboratories,系统特点,Xact,颈动脉支架不同部位网孔外形有所差异，具有以下特点：,U,型连接桥,S,性连接桥,不同的网孔大小,末端外扩,Representative of the Family of Stents,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,10,Company Confidential 2009 Abbott Laboratories,系统特点,:U,型连接,U,型和,S,型连接桥连接构成网孔的形态，并影响网孔的面积和径向支撑力,U,形连接桥可限制网孔扩大，以增加对病变血管壁的覆盖，最大限度稳定斑块,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,11,Company Confidential 2009 Abbott Laboratories,系统特点,:S,型连接桥,S,型连接桥的潜在优点：,增加支架的柔顺性和输送性,增加网眼的可变长度，减少对正常血管的金属覆盖率,确保支架能充分膨张,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,12,Company Confidential 2009 Abbott Laboratories,系统特点,:,不同网孔大小,不同网孔大小潜在好处：,大网孔改善支架的柔顺性和系统的跟踪性,大网孔对正常血管的金属覆盖率低,小网孔增加对斑块的覆盖，增加径向支撑力,Variable Cell Length,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,13,Company Confidential 2009 Abbott Laboratories,系统特点,:,末端外扩,末端外扩设计的好处是：,增加支架释放的稳定性,方便支架置入后其他介入器材的推送,减少支架对后扩球囊的损伤,保证回收,EPD,的通路，避免,EPD,与支架缠结,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,14,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,直形和锥形设计,20 mm,直形,30 mm,直形,30 mm,锥形,40 mm,锥形,Carotid Certification Training,AP2929160 Rev.A 2/09,15,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,20 mm,直形,straight,近端,5,个,U-,形连接的网孔,远端,3,个,S-,形连接的网孔,网孔长度顺应性变化,充分展开的支架直径：,7,8,9,10 mm,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,16,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,30 mm,直形,近端,5,个,U-,形连接的网孔,远端,5,个,S-,形连接的网孔,网孔长度顺应性变化,充分展开的支架直径：,7,8,9,10 mm,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,17,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,30 mm,锥形,近端,5,个,U-,形连接的网孔,远端,5,个,S-,形连接的网孔,网孔长度顺应性变化,锥型支架直径：,6-8,7-9,8-10 mm,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,18,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,40 mm,锥形,近端,4,个,S-,形连接的网孔,中段,6,个,U-,形连接的网孔,远端,4,个,S-,形连接的网孔,网孔大小从近端到远端有差异,锥型支架直径：,6-8,7-9,8-10 mm,Image courtesy of Jason Cumming,Carotid Certification Training,AP2929160 Rev.A 2/09,19,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,The,Xact,支架的选择需参考,:,病变的长度,参考血管的直径,手术方案,其他因素,:,支架的直径需大于参考血管直径的,1 to 1.5mm,Carotid Certification Training,AP2929160 Rev.A 2/09,20,Company Confidential 2009 Abbott Laboratories,系统特点,:,支架的尺寸和选择,Lumen Diameter Range for Proximal End(mm),Stent Diameter(mm),5.5 6.4,7.0,6.4 7.3,8.0,7.3 8.2,9.0,8.2 9.1,10