醫(yī)學(xué)交流課件：Willis覆膜支架臨床應(yīng)用體會(huì)

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1、Willis覆膜支架臨床應(yīng)用體會(huì) Willis覆膜支架治療示意圖 To close the opining of aneurysmTo close the fistula of AVF2021-12-103Willis覆膜支架結(jié)構(gòu)designation with 8-2 pattern, patent and sinusoidal waveCovered with ePTFE 50 umCoCr super alloy16mm覆膜支架實(shí)際長(zhǎng)度=覆膜覆蓋長(zhǎng)度+6mmCovered stent deployed in straight artery :Yellow head: stent stru

2、tsBlue head: ePTFE membraneDotted circle: aneurysm neck area 1m after deployment3m after deployment12m after deploymentWillis覆膜支架植入后內(nèi)皮化過(guò)程一、病人的選擇不適宜不適宜Willis覆膜支架應(yīng)用覆膜支架應(yīng)用靶血管（治療段）迂曲靶血管（治療段）近、遠(yuǎn)端管腔直徑落差過(guò)大靶血管（治療段）有重要?jiǎng)用}分支M 29y C6血泡樣動(dòng)脈瘤術(shù)前術(shù)后囊治F 56y 外傷性假性動(dòng)脈瘤術(shù)前術(shù)前術(shù)后術(shù)后3個(gè)月F 56y 外傷性假性動(dòng)脈瘤術(shù)前術(shù)中破裂！原因分析：10mm16mm二、支架的選擇硬

3、膜內(nèi)段（C6、C7、V4段）硬膜間（C4、C5段）硬膜外段（C2、C3、V2、V3段）在達(dá)到治療目的前提下長(zhǎng)度宜短不宜長(zhǎng)直徑宜等粗稍粗不宜細(xì)Pre-procedureIn-covered stentingImmediately after stenting M/48y, 后交通破裂動(dòng)脈瘤 3 ms later10 ms laterPre-procedureIn-covered stentingImmediately after-covered stentingF/45yF/45y，多發(fā)，多發(fā)破裂動(dòng)脈瘤破裂動(dòng)脈瘤柔順性要求女/38歲，C7破裂動(dòng)脈瘤術(shù)后術(shù)后6個(gè)月個(gè)月術(shù)前術(shù)前WillisWilli

4、s覆膜支架覆膜支架術(shù)前術(shù)前術(shù)后術(shù)后11個(gè)月個(gè)月WillisWillis覆膜支架覆膜支架女性，23歲，雙側(cè)外傷性CCF,M/58y,SAH，C7段動(dòng)脈瘤Willis覆膜支架治療術(shù)后7年復(fù)查術(shù)中術(shù)前F/48y, SAH,術(shù)中血栓事件支架過(guò)長(zhǎng)？術(shù)前術(shù)后即刻術(shù)后即刻術(shù)后術(shù)后10術(shù)后術(shù)后20術(shù)后術(shù)后30動(dòng)脈瘤直徑動(dòng)脈瘤直徑2 mm支架直徑支架直徑10 mm三、病種的選擇外傷性假性動(dòng)脈瘤、窄口動(dòng)脈瘤、低流量CCF動(dòng)脈壁破損復(fù)雜型動(dòng)脈瘤或CCF大、巨大動(dòng)脈瘤（彈簧圈輔助）高流量CCF（球囊/彈簧圈輔助）Pre-procedurePre-procedurePost-covered stenting28 mon

5、ths later術(shù)中術(shù)后即刻術(shù)后1年男/57y，鼻咽癌侵蝕頸內(nèi)動(dòng)脈覆膜支架修補(bǔ)M/38y,SAH，C7段巨大動(dòng)脈瘤彈簧圈術(shù)后復(fù)發(fā)Willis覆膜支架治療Willis術(shù)后術(shù)后18個(gè)月個(gè)月Willis術(shù)后術(shù)后3個(gè)月個(gè)月Willis術(shù)后即刻術(shù)后即刻Willis術(shù)中術(shù)中彈簧圈術(shù)后彈簧圈術(shù)后術(shù)前術(shù)前3ms after coilingPost-covered stentingPre-procedureM/ 37yM/ 37y，椎，椎動(dòng)脈動(dòng)脈V4V4段夾段夾層動(dòng)脈瘤層動(dòng)脈瘤 F 55y CCF術(shù)前術(shù)中術(shù)后術(shù)后術(shù)后6 6個(gè)月個(gè)月術(shù)后即刻術(shù)后即刻彈簧圈術(shù)后彈簧圈術(shù)后Willis術(shù)后術(shù)后M 32y，復(fù)雜型Willis治療l靶動(dòng)脈過(guò)度迂曲為禁忌；靶動(dòng)脈有重要?jiǎng)用}分支開(kāi)口為相對(duì)禁忌l靶動(dòng)脈和支架直徑要相匹配,宜稍大不宜小l支架長(zhǎng)度在達(dá)到目的前提下宜短不宜長(zhǎng)l主張單支架一次治療治愈l術(shù)后減少頭部運(yùn)動(dòng)，以免支架移位；推薦術(shù)后第二天CT和CTA檢查，觀察動(dòng)脈瘤內(nèi)血栓和支架情況l術(shù)前后規(guī)范抗血小板聚集治療，推薦術(shù)后肝素化72小時(shí)四、覆膜支架治療注意點(diǎn)四、覆膜支架治療注意點(diǎn)覆膜支架的理想要求貼壁支撐力好貼壁支撐力好 柔順和張力的統(tǒng)一順行性好順行性好謝謝！謝謝！