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Cardiology
Guide Catheters and Guidewires
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
10 sections · 137 slides
Overview
- Scope of this topic
Guide catheter construction
- Requirements of a guiding catheter
- Guide catheter wall layers
- Three-layer wall of the guide catheter
- Diagnostic versus guide catheter
- Guide catheter versus diagnostic catheter
- Comparison between 6 Fr diagnostic and 6 Fr guide catheter
- Components of the guiding catheter
- Basic components of the guide catheter
- Catheter size and the French scale
- Trade-offs of a larger guide catheter
- Indications for a 7 Fr guide catheter
- Selection of appropriately sized guide catheter
- Guide catheter length
- Side-hole guide catheters
Support and backup force
- Factors governing guide catheter selection
- Passive versus active guide catheter support
- Passive support
- Active support
- Backup force and the angle against the aortic wall
- Determinants of backup force
- Femoral versus radial backup with a JL catheter
- Support ranking of guide catheters by vessel
- Shaft stiffness and manufacturer differences
- Additional means of increasing guide support
- Primary and secondary curves of a guide catheter
- Catheter shape and curve nomenclature
- Catheter curve selection by aortic root
- Catheter selection on the basis of aortic size
Guides for transfemoral intervention
- Guide catheters for the left main
- Commonly used guides for the left coronary system
- Manipulation of left-system guides
- Judkins left guide catheter
- Judkins catheters engaging the coronary ostia
- Engagement technique with Judkins guides
- Extra backup guide catheters
- Curve geometry of extra backup catheters
- Long-tip Voda catheter and EBU engagement of the left main
- Extra backup catheters in the right coronary artery
- Amplatz guide catheters
- Amplatz guide catheters resting on the coronary cusp
- Push and turn manoeuvre for Amplatz withdrawal
- Right coronary artery anatomy and guide choice
- Catheters for the difficult-to-engage right coronary artery
- Technique for right coronary engagement
- Guide selection by right coronary takeoff
Bypass grafts and anomalous origins
- Internal mammary artery graft engagement
- Technique for mammary graft engagement
- Saphenous vein graft engagement
- Guides for anomalous coronary origins
- Dextrocardia and corrected transposition
Transradial guides and best practice
- Challenges of transradial guide selection
- Catheter sizing for the transradial approach
- Radial-specific and graft catheters
- Ikari left guide catheter
- Comparison between Judkins left and Ikari left catheters
- Three modifications of the Ikari left catheter
- Ikari right guide catheter
- Sheathless guide catheter system
- The sheathless guiding catheter system
- Sizing of sheathless guide catheters
- Best practices for guide catheter manipulation
- Further precautions in guide catheter handling
- Guide catheter selection by vessel and anatomy
Coronary guidewires
- Role of the coronary guidewire
- Evolution of guidewire technology
- Impact of over-the-wire technology on success rates
- Later advances in guidewire design
- Torquability and whip
- Torque delay and whip response of a guidewire
- Tactile feedback and trackability
- Tip flexibility, shapability and shape retention
- Tip load and support
- Structural components of a coronary guidewire
- Five components of a guidewire
- Guidewire shaft and standard dimensions
- Guidewire core and its material
- Guidewire core materials compared
- Core materials and their properties
- Effect of core diameter on flexibility and support
- Effect of taper length on guidewire behaviour
- Core diameter and taper length
- Guidewire tip designs
- Spring-coil and core-to-tip designs
- Guidewire body: coils and polymer covering
- Guidewire coatings, lubricity and tactile feedback
- Hydrophilic and hydrophobic coatings
Wire families and selection
- Principle of guidewire selection
- Workhorse wires
- Standard specifications of workhorse wires
- Workhorse wires: core construction
- Workhorse wires: tip, coating and length
- Polymer-coated wires
- Limitations and applications of polymer-jacketed wires
- Polymer-jacketed wires: core and diameter
- Polymer-jacketed wires: core and diameter (continued)
- Polymer-jacketed wires: tip design and tip load
- Polymer-jacketed wires: tip design and tip load (continued)
- Polymer-jacketed wires: radiopaque length and preferred use
- Polymer-jacketed wires: radiopaque length and preferred use (continued)
- Wire selection in tortuous and angulated vessels
- Wire selection in bifurcation lesions
- Wire selection in calcified lesions
- Extra support wires
CTO and specialty guidewires
- Principles of CTO guidewire selection
- Antegrade CTO wire escalation
- Initial exploration of a CTO
- Controlled penetration and resistant occlusions
- Retrograde CTO wires for collateral crossing
- Retrograde crossing strategies and escalation
- Knuckle wiring and wire externalisation
- Polymer-jacketed CTO guidewires
- Polymer-jacketed CTO guidewires (continued)
- Non-polymer-jacketed CTO wires
- Non-polymer-jacketed CTO wires (continued)
- Non-polymer-jacketed CTO wires (continued)
- Rotational atherectomy guidewires
- Physiological assessment guidewires
- Embolic protection wires
Summary
- Key points: guide catheters
- Key points: guidewires
- Conclusion
- References
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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