Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, highlighting how their structure provides support and torque control. It describes commonly used guide catheters like the Judkins, Amplatz and EBU catheters, noting what vessels each is best suited for. Specialty guide catheters for difficult anatomies are also reviewed. Proper guide selection and positioning are emphasized for coaxial engagement and optimal device delivery during interventions.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Interventional Radiology : Devices and Embolic Agents that a Resident NEEDS T...Saurabh Joshi
Interventional Radiology is full of various devices and materials. The general radiology resident needs to know these in order to impress the examiner. This file also contains information on various embolic agents.
Basics of Interventional Radiology and Vascular Interventions RVRoshan Valentine
Brief overview of the general principles of interventional radiology, DSA, vascular interventions, catheters, guidewires, patient management, complications
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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3. Introduction
• Guide catheters are the conduit for hardware delivery down the coronary
arteries.
• Proper guide selection makes a major difference during the intervention
procedure.
• Each guide catheter has its inherent properties – suited for specific situations.
4. Functions of a Guide Catheter
• Vehicle for contrast injection
• Measurement of Pressure
• Conduit for wire & device transport
• Support for device advancement
5. Features of guide catheter
• Preformed configuration – optimum support
• Adequate lumen and device compatibility
• Good torque control
• Kink resistance
• Atraumatic tip
8. Stiffness of guide catheter
• Shaft of guide catheter has
differential stiffness.
• Proximal push zone has high
stiffness.
• Distal tip is soft and flexible.
10. Guide vs Diagnostic catheter
Diagnostic catheter
• Thicker shaft
• Smaller inner diameter
• Tapered tip
• Usually has 2 layered construction
Guide catheter
• Thinner shaft
• Larger internal diameter
• Non tapered tip
• Has 3 layer reinforced construction.
11. Backup Force
F – force required to deliver hardware
down the coronary arteries
⍬ (theta) – angle subtended by the
guide catheter on the contralateral wall
of the aorta.
Fcos⍬ - destabilizing force which tends
to push the catheter upwards.
12. Backup Force
Larger the angle ⍬, greater is the
backup support.
Larger the angle ⍬, lesser the
destabilizing force (Fcos⍬).
As angle approaches 90º, support
increases.
13. Side holes
Side holes are advantageous in situations where damping is commonly
encountered
• RCA interventions
• CTO PCI
• PCI on unprotected LM
Allows perfusion to occur while the guide is engaged at the ostia.
14. Size compatibility
Guide catheters are
available in standard, large
and giant lumen sizes.
In large and giant lumens,
the outer layers are fused
together to increase lumen
area.
16. Guide catheter selection
Depends on multiple factors
• Anatomy of aorta
• Access
• Target vessel – location of ostia
• Type of lesion
• Vessel tortuosity/angulation
• Hardware to be used
17. Guide co-axial
Co-axial guide position is extremely
important during procedure.
Improves deliverability
Reduces trauma and complications.
18. Guide support
Ability to remain in position and allow delivery of hardware distally into the
coronaries.
Guide catheter support is mainly of 2 types –
• Passive support
• Active support
19. Passive support
• Strong Support offered by
• Inherent configuration of the catheter with good backup against opposite aortic wall
• Stiffness from manufactured material
• Additional manipulation is generally not required
• Mainly passive
• Eg.Amplatz
20. Active support
• Active support obtained by manipulation of guide catheter
• Guide manipulation –
Catheter conforms to the aortic anatomy and gives support
Deep intubation into the coronary ostia
• Eg. EBU
23. Commonly used guide catheters
• Judkins
• Amplatz
• Extra back up
• Multipurpose guide
24. Judkins Left (JL)
• Similar curves as diagnostic catheter (primary and
secondary curve)
• Easy cannulation
• Intubates small segment of LM ostium – reduced
trauma
• Ideal catheter in cases where LM ostia is diseased
• Guide support low (narrow point of contact on
aorta)
25. Judkins Right (JR)
• Most common guide used for RCA
interventions
• Primary, secondary and tertiary curve
• No point of contact on ascending aorta
• Poor guide support – may not be suitable
in tortuous vessels
26. Curve selection
Curve selection depends on
• Width of ascending aorta
• Location of ostia
• Orientation of vessel
Proper curve essential for co-axial
alignment.
27. Amplatz guide
• Secondary curve sits on the aortic cusp while
primary curve cannulates the ostia.
• Very good backup support
• Deep intubation of ostia – chance of ostial
dissection
• Not suitable in patients with ostial disease
28. Amplatz guide
• Commonly used – AL 0.75 and AL 1
• Size selection according to aortic size –
larger aorta may requireAL 2 or AL 3.
• Amplatz guide can cause significant aortic
regurgitation.
Main use in tortuous vessels or difficult
lesions (calcified plaque)
29. EBU (extra backup) guide
• Single primary curve and long tip
• Long tip allows co-axial engagement of
LCA
• Very good passive support – large contact
area with aorta
• Deep engagement of coronary ostia – risk
of dissection
• Not suitable in patients with LM ostia
disease
30. EBU (extra backup) guide
• Commonly used size –
EBU 3 / 3.5 (femoral)
• 1st choice for LCA interventions
31. LCA interventions
• Most common – EBU/XB
• Left main disease/ostial lesion – Judkins left (JL)
• Tortuous anatomy/very calcified lesions - Amplatz
32. RCA interventions
• Most common – Judkins right (JR)
• Tortuous anatomy, CTO, calcific lesions –
Amplatz (AL 0.75, AL 1)
• Superior take off RCA – JR, Hockey stick or
Amplatz
• Inferior take off RCA – Multipurpose guide
• Shepherd crook RCA – Amplatz
33. Special RCA catheters
3DRC (3 dimensional RCA catheter)
Designed to cannulate RCA with
minimal torque.
Suitable for ostial lesions
34. Special RCA catheters
ARANI
• Double loop catheter (S
configuration)
• Contact with aorta at 2 sites – very
good backup support
• Useful in Shepherd crook RCA
37. Trans-radial PCI
Commonly used catheters –
Left – EBU
Right – JR, Amplatz
Sizing – Downsize curve by 0.5 for radial procedures
38. Ikari catheter
• Modified Judkins Left catheter
• 3 differences in design from JL :-
Curve proximally to overcome
resistance at subclavian entry
Shorter secondary curve
Longer straight portion for more
support
45. Guide extension catheters
• Based on concept of mother
and child technique
• Meant for delivery of hardware
down the coronary – difficult
tracking
• Provides more support
47. Sheathless Guide
• Sheathless techniques with hydrophilic large lumen guiding catheters (Eucath, ASAHI,
Japan)
• Hydrophilic-coated sheaths - reduce the force required to remove them and prevent the
occurrence of spasm, improving patient comfort
57. CONCLUSION
• Guide catheters form the backbone of any intervention procedure.
• Adequate guide support is very important for smooth and fast procedure.
• Different guide catheters have different properties – suited for different
scenarios.
• Special catheters are available for extra support and abnormal ostia.
• Guide extension catheters help to overcome problem of trackability and
support in difficult anatomy and lesions.