PRESENTACIÓN MIN SALUD

8/6/2019 PRESENTACIN MIN SALUD

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NVUS 1190 12/06

Accidente Cerebro Vascular

EstadisticasEstadisticas: 15% de todos los ACV son hemorragicos vs. 85% isquemicos

55% de aneurismas detectadas son tratadas, 55% de aneurismas tratadas son con coils

El average de edad en pacientes es entre 40-60 aos

La incidencia en mujeres es de, 3:2

1 de cada 15 personas tendr un aneurisma durante su vida

Unruptured Ruptured


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Detalle de la EnfermedadAneurismas Cerebrales

Enfermedad de la Arteria

pared abombada.

Peligro de ruptura-HemorragiaSub Aracnoidea (SAH)

Nombrada por el vaso de donde

nace

Tratamiento: excluir el flujo

sanguineo Clipping, coiling, sacrificio de

arteria

Netter Presenter Image 2007 Icon Learning Systems. All rights reserved.


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Sitios comunes para Aneurismas

Sitios mas comunes: arteria cerebral media

carotida interna

comunicante anterior

punta de la basilar


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GDC Coil Oclusin

de Aneurisma

Illustration prepared by Boston Scientific-Neurovascular. Illustration not to scale.


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The EquipmentSingle Plane C-Arm

Used mostly for

peripheral and

cardiac interventions.

Photo taken by Boston Scientific representative.


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EquipoArco en C



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Monitores

Arriba:

AP

Lateral

Cada monitor

tiene losangulos de la

camara para

su facil

reubicacin



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Acceso VascularCaja de vista angiografica

La mayoria de los

estudios de hoy da

son digitales.

Los mdicos usan las

cajas de vista, para

revisar estudios viejos

referidos por

hospitales pequeos

con vieja tecnologa



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The EquipmentAnesthesia Equipment

This is an anesthesia

machine. Anesthesia

is used either forconscious sedation or

full anesthesia for

Interventional

procedures.



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The EquipmentProduct Storage

Our products are

often stored in

cabinets with rollerlockers.



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Vascular AccessSterilization

Betadine is applied

in a swirling pattern

at the groin site andsits for 3-5 minutes

before removing

excess.


Betadine is a registered trademark of Purdue Frederick.


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Vascular AccessGroin Exposure

The sterile prepped

groin is exposed for

puncture.



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Vascular AccessFemoral Identification

Palpate femoral pulse

to determine

puncture site.

Area is prepped for

supplies needed

during procedure.

(The red tip is the

SHEATH, which is

already attached to

the flush system).



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Vascular AccessLocal Anesthetic

E

Lidocane is used as a

local anesthetic to

numb the groin area.

C2.21



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Vascular AccessNeedle Puncture

E

In this picture, the left

hand is finding the

pulse and the righthand is using a 20

gauge needle (hollow)

to puncture femoral

artery for vascular

access.

C2.22



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Vascular AccessNeedle Puncture

E2.22


Arterial blood

return is the sign

of a successful

puncture.


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Vascular Access.035 Guidewire Placement

E

The access guidewire

placed inside of

puncture needle tosecure track inside

the vessel.

The needle is then

removed and

pressure is held until

a sheath is placed.

C2.23



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Vascular AccessSheath Placement

The sheath being slid

over the guidewire.

(The white with the

red tip is the sheath,

blue is the obturator)



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E2.24


Obturator

Sheath


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E2.24


Sheath is being

placed through

the skin.


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E2.24


Sheath is in and

connected to heparin

flush system


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Vascular AccessContinuous Flush

E

Drip chamber beingprepped for flushsystem.

Saline bag is notsterile.

Flush tubing is sterile.

A nurse or techmonitors flush toensure it iscontinuous duringprocedure.

C2.30



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Continuous Infusion Setup

One-way

Stopcock

Line to Flush Solution

RHV

Guidecatheter

RHV


Femoral

Sheath

Three-way

Stopcock

Line to Flush SolutionSyringe

Microcatheter

Illustrations prepared by Boston Scientific-Neurovascular. Illustrations not to scale.


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Vascular AccessFinal Set Up

E2.24


One-wayStopcock


RHVGuidecatheter

RHV


Femoral

Sheath

Three-way

Stopcock

Line to Flush SolutionSyringe

Microcatheter

Detachable

Coil


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CATETER GUIA GUIDER XF

VARIEDAD DE CURVAS

CONSTRUCCION DE DOBLE HEBRA=

MAYOR SOPORTE


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Guide Catheter Fundamentals

Example of where a guide catheter isseated:


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MICROCATETERES

Excelsior SL-10

Menor perfil con muy buen

lumen interno

Excelente para accesos tortuosos

y distales.

Menor diametro externo

Ideal para trabajar con Stent

NeuroformMicrocateter de Menor friccin

con Coils Matrix


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MICROCATETERES

Excelsior 1018

Lumen Interno extra-grande

Compatible con todos los coils

Punta Suave

Buena capacidad de embuje

Excelente Soporte

Compatibilidad con todos los

tipos de coils: Matrix, GDC-10,and GDC-18


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MICROGUIAS TRANSEND


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TIPOS DE COILS

3D Shape 2 Diameter SoftStandard Ultra-Soft*


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Soft

UltraSoft

SR2 Diameter

Comprehensive Solutions

for Aneurysm Treatment3D Shape


360


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GDC Standard Coil

GDC SoftGDC UltraSoft

GDC 10-Soft is 22% softer compared to GDC-10 Standard.*

GDC 10-UltraSoft is 50% softer compared to GDC-10 Soft*

GDC-10 UltraSoft Coils

*Bench testing on file at Boston Scientific . Bench results may not

necessarily be indicative of clinical performance.


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Why is a 2D Loop Important?

GDC Detachable Coils


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GDC 360 Coils

2D Loop = Liberacion Controlada

Forma complex = Menor Compartimentalizacion

DiferenteGrado de Suavidad = Mayor Adecuacin

Stretch Resistant = Reposicionamiento

Diseo 360


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GDC 360 Coils

Spherical

Elongated

Bi-lobed

Designed for the Treatment of All

Shapes of Intracranial Aneurysms

Images provided by Boston Scientific Neurovascular


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COIL MATRIX


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Como funciona el Matrix

1. Oclusion acelera formacion de trombos2. El copolimero se biograda

3. Bio-degradacion acelera la formacion de trombos

en tejido fibrocelular

**MatrixGLP animal study: Statistically significant results. Data on file at Boston Scientific Neurovascular.

**


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Example of Successful Matrix Coil

Case

2PT

038 rev103/03

Immediate Post

12 Month F/U3 Month F/U

Basilar ApexNon SAH

11X9mm Dome

4mm Neck

11 CoilsJackson Memorial, Miami

Results fromcasestudies arenot predictive of results ino thercases. Results inothercases mayvary.


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Marker Band Alignment

...See the light



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Main Coil Pusher Wire

Detach Zone

Non-Conductive

Plug

GDC Coil Detachment Zone



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Connecting Cables

Part #451102-4

Connecting Cables

& Terminals


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Detachable Coil Power Supply

Voltage Display

Current Display

Time Display

Check Circuit

Indicator

Power Button

Current Setting andResume Control

Low Battery Indicator

Detach IndicatorPower Supply

Part #451007-4


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STENT INTRACRANEAL NEUROFORM


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Aposicionatraumatica en laarteria

Mnimo acortamientopost-liberacion

(1.8% to 5.4%)*

Stent Auto expansible de NITINOL


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BUENA FLEXIBILIDAD Y FUERZA RADIAL


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Stent colocado

Marcas Radiopacas


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Wingspan Stent y Gateway

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PRESENTACIÓN MIN SALUD

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