Sunday, March 31, 2013 1

Doug Fraser

Manchester Heart Centre UK

Guide catheter choice

How is coronary angioplasty performed ?

1. Sheath placed

femoral / radial artery

2. Preshaped catheter

to coronary osteum

3. Narrowed area dilated, kept

open with a stent

What is a catheter ?

• 2 types - diagnostic pictures only - guide / guiding angioplasty

What do they look like ? Judkins

3cm

3.5cm

4cm

5cm

5F

6F

7F

Diagnostic Guide catheter

Simple

PCI

Routine

PCI

Complex

PCI

Diagnostic catheters

Judkins L

• Left JL 3.5 radial JL4 femoral

Judkins R – JR4

Multipurpose - Tiger

Anterior take-off RCA

• Amplatz left 1 = AL 1

Shapes used for coronary grafts

Venous Grafts

• JR4 all VGs • Multipurpose right coronary graft • AL1 all VGs

LIMA

• LIMA catheter • RCA catheter

Diagnostic catheter shapes

• Femoral

– Judkins - JL4, JR4

- large JL5

- small JL3.5

– Other - Williams, AL1

• Radial

– Judkins - JL3.5, JR4 - Tiger

Guide / Guiding catheters

Up to 250 shapes available

Guide catheter shape

Guide families JL

TIG RBL Kimny

EBU XB, CLS,

LBU, Muta,

FCL, Voda Ikari, RBL

JR

AL

ART

RBR

JL

TIG

EBU

JR

AL

Zuma

Soft/Active Stiff/Passive Balanced

Sherpa NX Active

Vista

Brite

Launcher

Viking

Optima Mach 1

Wise

Guide

Sherpa NX Balanced

Runway Viking Zuma 2

Guide construction

• 5F 0.059 Heartrail 0.058 Primum, Convey, Launcher 0.056 Brite tip

• 6F 0.071 Launcher, Primum 0.070 Brite tip, Mach 1, Sherpa, Zuma2

Most cases…

Left – extra backup types man 3.5 / 4.0 woman 3.0 / 3.5

Right Judkins JR4

Other shapes…

Femoral access – JL4 also

0

10

20

30

40

50

60

70

TRI TFI

resis

tance (

gra

m f

orc

e)

P<0.05

Upsloping RCA or support required

• AL0.75 or AL1

LCA guides – bilateral ‘TIG’

• coaxial JL, less support EBU type

Venous Grafts

• RCA VG JR4, Multipurpose • LAD VG JR4, AL1 • OM VG JR4, AL1

LIMA

• JR4 • LIMA

Guide catheter compatibility

• 5F simple PCI

• 6F thrombectomy

IVUS

kissing balloon

rotablation

distal protection

• 7F 2 stent techniques rotablation some devices

Summary • Diagnostic 5F / 6 F

– Femoral JL4, JR4 – Radial JL3.5, JR4, Tiger

• Guide – Left Extra backup men 3.5/4, women 3/3.5 – Right JR4 (AL1, AL0.75) – Vein graft JR4, AL1, Multipurpose – LIMA LIMA, JR4

– 6F (5F, 7F)

– Cordis Vista – Medtronic Launcher – Boston Mach 1