High Class Interventions

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narinder sharma

Narinder sharma Coronary Interventions

Healthcare

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

Judkins L
• Left JL 3.5 radial
JL4 femoral

Anterior take-off RCA
• Amplatz left 1 = AL 1

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

Diagnostic catheter shapes
• Femoral
– Judkins - JL4, JR4
- large JL5
- small JL3.5
– Other - Williams, AL1
• Radial
– Judkins - JL3.5, JR4
- Tiger

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/PassiveBalanced
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

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

Femoral access – JL4 also
0
10
20
30
40
50
60
70
TRI TFI
resistance(gramforce)
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

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

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There are two basic IVUS catheter designs: mechanical/rotational and solid state. The mechanical catheters (OptiCross IVUS catheter, Boston Scientific, Santa Clara, California; Revolution IVUS catheter, Volcano, Rancho Cordova, California; ViewIT IVUS catheter, Terumo, Tokyo, Japan; and Kodama HD IVUS catheter, ACIST Medical Systems, Eden Prairie, Minnesota) consist of a single transducer element located at the tip of a flexible drive cable housed in a protective sheath and operated by an external motor drive unit. The drive cable rotates the transducer around the circumference (1800rpm) and the transducer sends and receives the ultrasound signals at 1° increment to form the cross-sectional image. The imaging catheters operate at a central frequency of 40 MHz or 60 MHz and are 5F or 6F compatible [Figure 1]A. In the solid-state catheter design (Eagle Eye Catheter, Volcano), no rotating components are present. There are 64 transducer elements mounted circumferentially around the tip of the catheter. The transducer elements are sequentially activated with different time delays to produce an ultrasound beam that sweeps around the vessel circumference. The catheter works at a central frequency of 20 MHz and is 5F compatible

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