Guide catheter choice

Guide catheter choice
Doug Fraser
Manchester Heart Centre UK
Sunday, March 31, 2013
1
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
- guide / guiding
pictures only
angioplasty
What do they look like ? Judkins
3cm
3.5cm
4cm
5cm
Diagnostic
Guide catheter
5F
Simple
PCI
6F
Routine
PCI
7F
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
• Multipurpose
• AL1
all VGs
right coronary graft
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
JL
TIG
Kimny
RBL
TIG
EBU
EBU XB, CLS,
LBU, Muta,
FCL, Voda
JR
RBR
JR
AL
Ikari, RBL
AL
ART
Guide construction
Sherpa NX Active
Wise
Guide
Runway
Zuma 2
Viking
Mach 1
Optima
Soft/Active
• 5F
• 6F
Sherpa NX Balanced
Launcher
Viking
Vista
Brite
Balanced
Zuma
Stiff/Passive
0.059 Heartrail
0.058 Primum, Convey, Launcher
0.056 Brite tip
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
resistance (gram force)
70
P<0.05
60
50
40
30
20
10
0
TRI
TFI
Upsloping RCA or support required
• AL0.75 or AL1
LCA guides – bilateral ‘TIG’
•
coaxial JL, less support EBU type
Venous Grafts
• RCA VG
• LAD VG
• OM VG
JR4, Multipurpose
JR4, AL1
JR4, AL1
LIMA
• JR4
• LIMA
Guide catheter compatibility
• 5F
• 6F
• 7F
simple PCI
thrombectomy
IVUS
kissing balloon
rotablation
distal protection
2 stent techniques
rotablation
some devices
Summary
• Diagnostic
5F / 6 F
– Femoral JL4, JR4
– Radial
JL3.5, JR4, Tiger
• Guide
–
–
–
–
Left
Right
Vein graft
LIMA
Extra backup men 3.5/4, women 3/3.5
JR4 (AL1, AL0.75)
JR4, AL1, Multipurpose
LIMA, JR4
– 6F (5F, 7F)
– Cordis
– Medtronic
– Boston
Vista
Launcher
Mach 1