High Class Interventions
- 1. Sunday, March 31, 2013 1 Doug Fraser Manchester Heart Centre UK Guide catheter choice
- 2. 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
- 3. What is a catheter ? • 2 types - diagnostic pictures only - guide / guiding angioplasty
- 4. What do they look like ? Judkins 3cm 3.5cm 4cm 5cm
- 7. Judkins L • Left JL 3.5 radial JL4 femoral
- 8. Judkins R – JR4
- 10. Anterior take-off RCA • Amplatz left 1 = AL 1
- 11. Shapes used for coronary grafts
- 12. Venous Grafts • JR4 all VGs • Multipurpose right coronary graft • AL1 all VGs
- 13. LIMA • LIMA catheter • RCA catheter
- 14. Diagnostic catheter shapes • Femoral – Judkins - JL4, JR4 - large JL5 - small JL3.5 – Other - Williams, AL1 • Radial – Judkins - JL3.5, JR4 - Tiger
- 15. Guide / Guiding catheters
- 16. Up to 250 shapes available
- 18. Guide families JL TIG RBL Kimny EBU XB, CLS, LBU, Muta, FCL, Voda Ikari, RBL JR AL ART RBR JL TIG EBU JR AL
- 19. 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
- 20. Most cases…
- 21. Left – extra backup types man 3.5 / 4.0 woman 3.0 / 3.5
- 23. Other shapes…
- 24. Femoral access – JL4 also 0 10 20 30 40 50 60 70 TRI TFI resistance(gramforce) P<0.05
- 25. Upsloping RCA or support required • AL0.75 or AL1
- 26. LCA guides – bilateral ‘TIG’ • coaxial JL, less support EBU type
- 27. Venous Grafts • RCA VG JR4, Multipurpose • LAD VG JR4, AL1 • OM VG JR4, AL1
- 29. Guide catheter compatibility • 5F simple PCI • 6F thrombectomy IVUS kissing balloon rotablation distal protection • 7F 2 stent techniques rotablation some devices
- 30. 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