波科外周guidewires中文導(dǎo)絲

1、Peripheral Guide Wires:外周介入導(dǎo)絲：Standard, Hydrophilic & Specialty標(biāo)準(zhǔn)，親水性 & 特殊,This document is intended for internal educational purposes only and shall not be distributed outside of Boston Scientific.,PI Guide W

2、iresOverview,Purposes of a guide wire:導(dǎo)絲的作用：Gain access into vessels 到達(dá)目標(biāo)血管Deliver devices 輸送手術(shù)器械Cross lesions 穿越病變部位Used in vascular and non-vascular procedures可用于血管和非血管介入手術(shù)Used in all diagnostic and

3、therapeutic procedures可用于所有的診斷和治療介入手術(shù)The Backbone of every procedure 每例介入手術(shù)均需使用,PI Guide WiresGeneral Features & Intended Benefits,,PI Guide Wires General Components外周介入導(dǎo)絲的一般結(jié)構(gòu),Core Wire: Usually Stainless Ste

4、el or Nitinol導(dǎo)絲軸芯：通常為不銹鋼和鎳鈦諾合金,,,Distal Tip: Working end of wire; comes in multiple shapes: straight, angled, shapeable, J遠(yuǎn)端頭端：導(dǎo)絲的工作端；有多種形狀：直型，成角型，可塑性，J型,,,Lubricious Coating: PTFE, Silicone, or Hydrophilic光滑涂層：PTFE，硅

5、，或親水性,,Distal Tip遠(yuǎn)端,Safety Ribbon安全帶,Core wire軸芯,Coil wire螺旋金屬絲,,,Proximal End近端,,Floppy/Light Support (POBA): Starter? Guide Wire松軟型/輕度支撐（POBA）：StarterTM 導(dǎo)絲Most flexible; least rail support 最佳的柔韌性；最小的支撐力Les

6、s likely to cause vessel damage 最小的血管損傷Moderate Support (Stent): Magic Torque? Guide Wire中度支撐（支架）： Magic Torque? 導(dǎo)絲Rail support between Floppy & Extra Support 介于松軟型 & 超硬導(dǎo)絲之間Added support for stent

7、delivery 為放置支架提供額外的支撐Extra Support (Stent): Amplatz Guide Wire額外支撐（支架）： Amplatz 導(dǎo)絲Long rail support region, but soft tip 桿身支撐力更強(qiáng)，柔軟的頭端Designed for first generation stent delivery 設(shè)計(jì)用于放置第一代的支架,PI Guide

8、 WiresCore Wire – Flexibility & Support軸芯 – 柔韌性 & 支撐力,Diameters most commonly used in interventions:在介入手術(shù)中最常使用的導(dǎo)絲直徑：.014” - Coronary and small vessel balloons - 冠狀動(dòng)脈和小血管球囊.018” - Renal and small

9、vessel balloons - 腎動(dòng)脈和小血管球囊.035” - Balloons and catheters, “workhorse” - 球囊和導(dǎo)管，“使用最普遍”.038” - Large devices requiring extra support (rarely used) - 需要額外支撐的較大器械（很少使用）Other less comm

10、on diameters are .032” and .025” 其他較少使用的直徑： .032” 和 .025”Trend towards smaller diameters (.014”) 趨向于小直徑導(dǎo)絲（.014”）Common guide wire lengths:通常的導(dǎo)絲長度：75cm, 150cm, 180cm, 260cm, 300cm,PI Guide WiresSizing – Dia

11、meters & Lengths尺寸 – 直徑 & 長度,PI Guide WiresDistal Tip Configurations遠(yuǎn)端頭端的類型,Tip Configurations:頭端類型：Straight, angled, J-Tip 直型，成角型， J型Non-hydrophilic, hydrophilic 非親水性，親水性Standard, floppy, stiff 標(biāo)

12、準(zhǔn)型，松軟型，硬型Tip taper 漸細(xì)的錐形頭端,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 perforati

13、on. 無創(chuàng)傷 – 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 s

14、old by Boston Scientific are:Standard Guide Wires 標(biāo)準(zhǔn)導(dǎo)絲Starter? Guide Wire (includes Bentson, Newton, & Rosen shapes)Hydrophilic Guide Wires 親水性導(dǎo)絲ZIPwire® Guide Wire (.18”, .025”, .035”, .038")S

15、pecialty Guide Wires 特殊導(dǎo)絲V-18? Control Wire® Guide Wire (.018")Platinum PLUS? Guide Wire (.014”, .018“, .025”)Thruway? Guide Wire (.014" & .018")Magic Torque? Guide Wire (.035")Ampla

16、tz Super Stiff? Guide Wire (.035“ & .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

17、Manufacturing, Inc. Any copying, sharing and/or distributing is prohibited.,Starter? Guide WireProduct Positioning,A family of ultra-smooth, PTFE guide wires.,Workhorse guide wire for routine procedures.,,Starter? Gui

18、de 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 WirePr

19、oduct 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

20、 or moveable core (not available in all sizes).,Starter? Guide WireFeatures & Intended Benefits,Starter? Guide WireAreas of Clinical Use,Gaining access for routine procedures,,Starter? Guide WireKey Competitors,Th

21、e 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 Angiodynamics Cordis St. Jude Bard Merit,,,

22、,Starter? Guide WireKey Takeaways,Atraumatic, workhorse guide wire for routine procedures. Pre-Coat TechnologyDipped coating for excellent coating durability & consistency Finger straightenable J-tip Availabili

23、ty of heparin coating Moveable & fixed core options,Sprayed Coating,Starter? Guide Wire Dipped Coating (a.k.a. “Pre-Coat Technology”),,,,GuidewiresConstruction - non hydrophilic wires

24、,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 pushability and support for Catheter Exchang

25、ePrecoat 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

26、Moveable Core allows adjustment of the Floppy Tip length meaning one wire can provide both safety and support Well balanced body provides ample pushability and support for Catheter ExchangePrecoat technology allows fo

27、r ease of Catheter ExchangeLarge Size Matrix covers majority of clinical requirements,Starter? Guidewire – Newton,Ideal wire to use for accessing delicate vessels and crossing fragile lesions such asRenal, Dialysis Fis

28、tula, 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? Guid

29、ewire – 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 navigati

30、on of heavily diseased Iliacs and Aortas.Very Atraumatic Tip, less support than Newton means that catheter exchange may be limited,Starter? Guidewire – Rosen Heavy Duty,Ideal wire to use for catheter access where additi

31、onal 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 more suitable,ZIPwire® Hydrophilic Guide Wire

32、s ZIPwire® 親水性導(dǎo)絲,ZIPwire® Guide Wire,ZIPwire® Guide Wire產(chǎn)品定位,A family of hydrophilic guide wires designed for smooth passage through tortuous anatomy.設(shè)計(jì)用于流暢的通過迂曲的解剖結(jié)構(gòu),ZIPwire® Guide Wire適應(yīng)癥,INDICA

33、TIONS: The ZIPwire Hydrophilic Guide Wire is intended to facilitate the placement of devices during diagnostic and interventional procedures.ZIPwire 親水性導(dǎo)絲用于在診斷性和治療性介入手術(shù)中協(xié)助置入器械。,ZIPwire® Guide Wire產(chǎn)品技術(shù)參數(shù),ZIPwire i

34、s a trademark of Boston Scientific Corporation or its affiliates. Glidewire is a trademark of Terumo Corporation.,Note: See Guide Wires brochure or price book for all available combinations.注意：請(qǐng)參見相關(guān)產(chǎn)品彩頁或手冊(cè)了解所有的產(chǎn)品型號(hào),ZIP

35、wire® Guide WireEnhanced Manufacturing Process,,A polymer jacket is extruded over a kink-resistant nitinol core. 聚合物外殼覆蓋在抗扭曲的鎳鈦諾合金軸芯表面Hydrophilic coating is bonded to the polymer jacket.親水性涂層粘合在聚合物外殼上,Radiopaq

36、ue Polyurethane Jacket 不透X線的聚亞安酯外殼,Nitinol Core鎳鈦諾軸芯,Hydrophilic Polymer Coating親水性聚合物涂層,The manufacturing process enhancements treated the surface of the polyurethane jacket for consistent adhesion of the hydrophilic

37、 coating.,ZIPwire Properties,Kink-resistant抗扭曲性The nitinol metal alloy core provides the strength necessary to make the ZIPwire guidewire kink-resistant. 鎳鈦諾合金材質(zhì)的導(dǎo)絲軸芯使ZIPwire導(dǎo)絲具有良好的抗扭曲性能。Steerable操控性Single p

38、iece construction and atraumatic tip allow excellent steerability. 一體式結(jié)構(gòu)和無創(chuàng)性頭端使其具有優(yōu)異的操控性。The unique alloy core and polyurethane jacket of the ZIPwire guidewire provide a true 1:1 torque response. 獨(dú)特的合金軸芯和聚

39、亞安酯外殼實(shí)現(xiàn)了1:1扭控反應(yīng)。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. 親水性涂層在水化后變得非常光滑

40、，易于到達(dá)病變部位和推送導(dǎo)管。,ZIPwire Properties,Low Thrombogenicity (tendency to produce blood clots)低血栓性（產(chǎn)生凝血塊的趨勢(shì)）The frictionless coating results in low potential for the formation of blood clots on the surface of the ZIPwire gu

41、idewire. 光滑的親水涂層有效減少了在導(dǎo)絲表面形成血凝塊的危險(xiǎn)。Radiopaque顯影性The polyurethane is impregnated with tungsten, a radiopacifier for enhanced visibility. 聚亞安酯外殼中含有鎢，在X線下具有良好的可視性。Atraumatic無創(chuàng)性The various cores result in s

42、oft, flexible tip configurations. 不同的軸芯 – 各種類型的柔軟而富有彈性的頭端。,ZIPwire® Guide WireFeatures & Intended Benefits,ZIPwire® Guide Wire臨床應(yīng)用領(lǐng)域,,,Aortic bifurcation area腹主動(dòng)脈分叉,,Carotids頸動(dòng)脈,,HAM血透通路,,Crossin

43、g CTOs通過完全阻塞的病變Subintimal Angioplasty內(nèi)膜下血管成形術(shù),ZIPwire® Guide WireKey Competitors,Glidewire® Guide Wire (Terumo - previously sold by Boston Scientific)- Hydrophilic market leaderRoadrunner® Guide Wire

44、 (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 designed fo

45、r maneuvering through tortuous anatomy.ZIPwire 親水性導(dǎo)絲設(shè)計(jì)用于通過迂曲的解剖結(jié)構(gòu)。 Precise 1:1 torque response 精確的1:1扭控反應(yīng) Highly radiopaque jacket 高顯影性外殼 Comprehensive selection of shafts, lengths, and tips 有多種不同硬度、長度和頭端類型

46、的型號(hào),Amplatz Super Stiff? Guide Wire Amplatz Super Stiff? 超硬導(dǎo)絲,Amplatz Super Stiff? Guide Wire 產(chǎn)品定位,A stiff, secondary (non-starter) wire when strength and stability are required for catheter placement and exchange.硬度更

47、高，具有更高的強(qiáng)度和穩(wěn)定性，用于放置和更換導(dǎo)管。,Amplatz Super Stiff? Guide Wire 適應(yīng)癥,INDICATIONS:The Amplatz Super Stiff Guide Wire facilitates catheter placement and exchange during diagnostic or interventional procedures. It is not intended

48、 for use in coronary arteries.Amplatz Super Stiff超硬導(dǎo)絲用于在診斷性和治療性介入手術(shù)中放置和更換導(dǎo)管。不適用于冠脈手術(shù)。,Amplatz Super Stiff? Guide Wire 產(chǎn)品技術(shù)參數(shù),Note: See Guide Wire brochure or price book for all available combinations.注意：請(qǐng)參見相關(guān)產(chǎn)品彩頁或手冊(cè)了解

49、所有的產(chǎn)品型號(hào),,Amplatz Super Stiff? Guide WireFeatures & Intended Benefits,Amplatz Super Stiff? Guide Wire臨床應(yīng)用領(lǐng)域,,Aortic bifurcation area主動(dòng)脈分叉,,Carotid/aortic arch area頸動(dòng)脈/主動(dòng)脈弓,Amplatz Super Stiff? Guide WireKey Compe

50、titors,“Amplatz” is a standard wire name sold by other companies including Cook and Cordis. Others competing wires include: Wholey HI-TORQUE (Covidien) HI-TORQUE Supra Core® (Abbott Vascular),Amplatz Super Stiff

51、? Guide WireKey Takeaways,Very supportive wire 具有高支撐力For secondary use (not for gaining initial access) 第二根導(dǎo)絲（不作為進(jìn)入導(dǎo)絲）Strong enough to get through tight lesions, yet tip is soft enough for reduced trauma during

52、advancement. 具有足夠的強(qiáng)度通過狹窄病變，同時(shí)柔軟的頭端可避免在推進(jìn)導(dǎo)絲時(shí)損傷血管。,Amplatz Super Stiff? Guidewire,,Super stiff wire body with an atraumatic tip for catheter placement and exchange in uroradiology, biliary drainage, abscess drainage and

53、 vascular procedures. 具有良好硬度的桿身和無創(chuàng)性頭端，可用于在泌尿系統(tǒng)、膽道引流、膿腫引流和血管介入手術(shù)中放置和更換導(dǎo)管。PTFE Coating helps to reduce friction and allows for easy catheter passage PTFE涂層減少了摩擦力，便于推進(jìn)導(dǎo)管。,在具有出色的硬度、強(qiáng)度、穩(wěn)定性的同時(shí)柔軟的無創(chuàng)傷頭端有良好的安全性,Magic Torque?

54、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 challenges of difficult anatomy.,Magi

55、c 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 to

56、rtuous arteries and/or avoid unwanted side branches.,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

57、Clinical Use,.035,3CM,50CM,GLIDEX,180 / 260CM,,Aortic bifurcation area,,Carotid/aortic arch area,,SFA/BTK,Magic Torque? Guide Wire Key Competitors,The Graduate Measuring Wire (Cook) Wholey-HI-TORQUE Guide Wire (Covidi

58、en) 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 Torque?Gli

59、dex? Coated Hydrophilic 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

60、is great for delivering Stent / Balloon CathetersMarkers make correct stent sizing easy and avoid any parallax effect,Meier Wire (Backup Meier),Meier Guide Wire Product Positioning,.035,3CM,50CM,GLIDEX,180 / 260CM,Firs

61、t 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,INDICATIONS:The Back-Up Meier St

62、eerable 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,

63、Meier Guide Wire Features & Intended Benefits,.035,3CM,50CM,GLIDEX,180 / 260CM,Meier Guide Wire Areas of Clinical Use,GLIDEX,,AAA,Meier Guide Wire Key Competitors,Cook Lunderquist® Extra Stiff Guide Wire Als

64、o referred to as the “coat hanger”,Very supportive wire for AAA procedures.Highly radiopaque gold-plated tungsten spring coil tip is designed to enhance visualization for more accurate placement.,Meier Guide Wire Key T

65、akeaways,Back-up Meier? Steerable Guidewire,Balancing the support, flexibility and radiopacity required for efficient catheter placement,,Optimally stiff stainless steel shaft coreStraightens tortuous anatomyProvides t

66、he “railroad 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 (dissec

67、tion)Minimizes the risk of dislodging thrombus from the aorta Highly radiopaque gold-plated tungsten spring coil tipProvides excellent visibility of the wire under fluoroscopy for accurate placementPTFE coated proxim

68、al shaftPromotes smooth catheter advancementReduces the risk of thrombus formationLarge device easily tracks on PTFE shaft,Platinum PLUS? Guide Wire,Platinum PLUS? Guide WireProduct Positioning,.035,3CM,50CM,180 / 26

69、0CM,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,G

70、LIDEX,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 tor