6颈内动脉狭窄的血管内治疗5
2018-8-27 来源：不详 浏览次数：次GuideCatheterPlacementforaLong6FCatheter
长的6F导管置入造影导管
Thistechniqueisidealforplacementofanystentwithadistalembolicprotectiondevice.Forthistechnique,theCookShuttleisanidealguidecatheter.ForplacementoftheCookShuttle,anexchangewireisadvancedthroughthefemoralarterysheathandplacedinthedescendingaorta.Underfluoroscopicvisualization,theexistingfemoralarterysheathisthenexchangedoverthewirefortheCookShuttle.TheCookShuttleanddilatorareadvancedoverthewireintopositioninthedescendingaorta,andthewireandsheathsubsequentlyremoved.TheCookShuttleisnowinpositionforselectionofthetargetvessel(Fig.21.4a).AVTKcatheter(Vitek,CookMedical,Bloomington,IN)maybeusedforselectionoftheleftorrightICA,whereasanangledSlipcatheter(CookMedical,Bloomington,IN)canbeusedfortherightCCA.TheVTKcatheterisadvancedinaleft-to-rightdirectionacrosstheaorticarch,withitstippointedcephalad.Thetargetvesseliscatheterizedwithdirectfluoroscopicvisualization(Fig.21.4b).BiplanefluoroscopyandroadmaptechniquearehelpfulinsafelyadvancingtheguidecatheterintopositionintheCCA.TheAPplaneiscenteredsuchthattheVTKcatheterandCookShuttleareseenintheaorticarch.ThelateralplaneiscenteredsuchthatthecarotidbifurcationisinclearviewsothattheECAmaybeselectedandcathetersadvancedoverthewireintopositionwithoutdisturbingthecarotidplaque.Onceviewsareselected,aroadmapofthetargetvesseliscreated,andastiff0.-inchorstandard0.-inchexchange-lengthguidewireisdirectedintotheECAunderdirectfluoroscopicinspectionwithroadmapguidance,takingcaretoavoiddisturbingthecarotidplaque(Fig.21.4c).ForaCCAlesion,astiffwirewithaJ-tip(AmplatzJ,CookMedical,Bloomington,IN)isbroughtintopositioninthedistalCCA,takingcaretoavoiddisturbingthecarotidplaque.TheVTKcatheterisheldinplaceasisthewire,andtheCookShuttleisadvancedovertheVTKcatheterandwireuntiltheCookShuttleisinplacewithintheCCA,proximaltothestenosis(Fig.21.4d).Incaseswhereatortuousinnominateartery–rightCCA引起白癜风原因是什么北京什么医院治疗白癜风比较好
