心臓カテーテル検査 - UMIN一般公開ホーム ...

1 1. CAG LVG. 2. ( ) .. 3. (EPS) .. ( :Cardiac Output) . Swan-Ganz ( ).. 1. PCWP(Pulmonary Capillary Wedge Pressure). 2. PAP(Pulmonary Arterial Pressure). 3.. ( ) (3 5 ) .. 4. RVP(Right Ventricular Pressure).. 5. RAP(Right Atrium Pressure) .. (RAP) 0-8mmHg . 5mmHg . (RVP) 17-35mmHg . 1-7mmHg . (PAP) 17-35mmHg . 4-13mmHg . 5-13mmHg . (PCWP) 15mmHg . * .. 98% 75%. 98%.. 75%. 98%.. 75%. ( ) . 4 8 L/min .. 1 (SV : Stroke Volume) 60 130ml 1 =SV/ 30 60 ml/beats/m2.. 1min . ( : Cardiac Index) .. ( ) Fick.

2 Fick . Forrester Swan-Ganz . (PCWP) . ( ) Forrester .. Killip .. ( ).. ( ).. (EPS : Electro Physiological Study).. EPS .. HRA. His HB. RVA. CS. TACE STENT GRAFT PTA. HCC (Hepatocerlar carcinoma: ) . 1.. TACE (Trancecatheter Arterial ChemoEmbolization). TAE (Trancecatheter Arterial Embolization).. Lip-TACE ( ). Lipiodol emulsion + . (HCC) .. Gelpart Lipiodol . PVA ( ). ( ). (Embosphere Embozene HepaSphere DC Bead).. STENT GRAFT.. 5cm .. 4cm . GORE TAG.. 2cm . GORE Excluder 15mm . 60 . 15mm . 10mm.

3 Stent graft over-the-wire . ( 18-20F). stent graft .. endoleak .. endoleak type I .. type II .. type III . type IV .. type I , type III . stent graft Zenith TX2 Talent TEVAR. Zenith Flex Power Link PTA. (Peripheral Artery Disease: ) . Buerger . ASO (Arteriosclerosis obliterans : ) . 2.. 1 :80 90%.. POBA stent .. 1 :50 70%.. POBA stent . - .. ( :CLI(critical limb ischemia)) ). POBA . 3.. (antegrade approach) . (retrograde approach) . (bidirectional approach) 2 . ( ). Cross-over approach : .. PAD.

4 ( ) ( ) ( ).. 100 90 35 25 . ( ) . 90 7 35 7 .. 25 55 35 . ( ). 4.. Parent . Destination . Shuttle .. ( ) .. 4.. semi-compliant balloon non-compliant balloon .. ( 7-10mm 5-7mm 3 3-5mm).. 8 12cm long balloon .. Point . recoil ( ) (deflate) . 5.. balloon expandable stent ( ). radial force Palmaz Express LD. / .. self-expandable stent ( ).. SMART Control E-Luminexx Wallstent RP. JOSTENT SelfX. Zilver non stenting zone .. 6.. CTO . IVUS.. (PTRA). (FMD).. (ARAS). Stent .. or .. OptEase Gunter Tulip Non-vascular IVR ( IVR).

5 PTCD (percutaneous transhepatic cholangio drainage) . PTGBD (percutaneous transhepatic gallblader drainage) . PNS (percutaneous nephrostomy) .. CAS .. iliac A.. (25cm) . (90cm) .. 6/7/8Fr ( ) ( ) . ( ) .. standard standard . harfstiff stiff or Amplatz 300cm .. PETE ( ). over-the wire (10,14,18 ). flow-guided . flow-direct 2 .. /reshape / / / .. X .. Y .. CAS (carotid artery stenting : ). 1.. CEA(carotidendartelectomy: ) . 50% 80% . ( ). 2.. EPD (Embolic protection device) . ( distal 50 60% ) ( 1.)

6 Or 2mm) EPD .. ACT(activated clotting time: ). 250 300 . embolic protection device (EPD). balloon protection filter protection GuardWire ANGIOGUARD XP FilterWire EZ.. FilterWire EZ 1 .. Carotid Wallstent Monorail (closed-cell ). Self-expandable stent . Closed Cell Design . 50% .. 3.. ANGIOGURD XP protection device . PRECISE STENT. stent(PRECISE) ( ) . (open-cell ).. Debris .. Distal balloon protection Filter protection Proximal balloon protection Flow reversal debris .. 4.. Carotid Sinus .. 1.. 10 15.

7 1. 5 7mm . 2. 5mm . A . B .. C Dome neck aspect .. 2009 .. ( or ). Grade - . 72 . Grade .. Grade .. 2009 .. 2.. 1 3 filling coil 2 flaming coil Coil . frame . (stretch-resistant(SR) ). 4 finishing coil Coil . frame .. Coil (3D-DSA ) Coil . Coil mass .. 3. flaming 1 2 3 4. 1.. 2.. 3.. 4.. angle .. bleb neck .. coiling technique ( ). Double catheter technique 2 . 2 1 neck . 2 . Balloon assist technique neck . wide neck .. Stent assist technique Wide neck .. Closed cell 7mm . dome/neck 2 or neck 4mm broad neck VRD.

8 VRD . VRD cell .. IDC Coil .. Detach . but .. GDC DCS Orbit Micrus Microplex EDC.. 1min . US (Ultipaque) (ES). 3D,360 Complex Sphere,Cashmere Complex Spiral 2D,spiral Helical Helipaque Helical Strech-Resistant .. 1D . 2D . 3D . ( ). ( ). Stretch-resistance (SR) .. ( ) .. bioactive coil . Matrix ( 30%) / . (PGLA, 70%) . Cerecyte Strech resistant H2O. H2O. H+. Hydrocoil H+.. H+ H2O. H2O.. 1 . ( ) . ( ) . CT .. 1.. ( ).. CT . 6 . 3 . rt-PA .. 2009 . Merci Retrieval System .. Merci . Merci .. Merci.

9 Merci .. Penumbra system .. -50mHg .. IVR .. FPD .. CT,MRI.