This document discusses various aspects of guide catheters and guidewires used in percutaneous coronary interventions. It describes the construction, properties, and types of guide catheters as well as strategies for selecting the appropriate guide catheter for different coronary arteries and lesion characteristics. It also explains the components, coatings, and ideal properties of guidewires and provides details on guidewire selection for different scenarios including chronic total occlusions.
This document provides information about coronary guidewires. It discusses the history of angioplasty and development of over-the-wire balloon systems. It describes the key components and characteristics of guidewires, including the core, tip, coils, covers, and coatings. It explains properties like torque control, trackability, steerability, and flexibility. It also covers classifications of guidewires based on tip flexibility, device support, coating, and clinical scenario. Examples of commonly used guidewires are provided.
This document discusses different techniques for percutaneous coronary intervention (PCI) of bifurcation lesions. It begins by defining a bifurcation lesion and classifying them using the Medina classification system. It then describes commonly used PCI strategies such as provisional stenting, crush, culotte, T stenting, and kissing stents. Several studies comparing outcomes of single versus two stent techniques and crush versus culotte are summarized. The document concludes by emphasizing keeping PCI procedures for bifurcation lesions safe, simple and swift.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
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.
This document provides information about coronary guidewires. It discusses the history of angioplasty and development of over-the-wire balloon systems. It describes the key components and characteristics of guidewires, including the core, tip, coils, covers, and coatings. It explains properties like torque control, trackability, steerability, and flexibility. It also covers classifications of guidewires based on tip flexibility, device support, coating, and clinical scenario. Examples of commonly used guidewires are provided.
This document discusses different techniques for percutaneous coronary intervention (PCI) of bifurcation lesions. It begins by defining a bifurcation lesion and classifying them using the Medina classification system. It then describes commonly used PCI strategies such as provisional stenting, crush, culotte, T stenting, and kissing stents. Several studies comparing outcomes of single versus two stent techniques and crush versus culotte are summarized. The document concludes by emphasizing keeping PCI procedures for bifurcation lesions safe, simple and swift.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
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.
The document discusses coronary guidewires, which are used to access and cross coronary lesions during angioplasty procedures. It provides a brief history of angioplasty and guidewire development. The key components and characteristics of guidewires are described in detail, including core material, tapering, tip design, coil placement, covers, coatings, and how these influence flexibility, torque, and other performance factors. Common guidewire classifications and specific guidewire models are also mentioned along with guidance on optimal guidewire positioning and potential complications.
This document discusses guiding catheters used in percutaneous coronary interventions. It describes the functions and structure of guiding catheters, including their layers, sizes, lengths and differences from diagnostic catheters. Factors that can cause dampening of arterial pressure are outlined. Techniques for shortening guiding catheters and various types of guiding catheters including Judkins and Amplatz catheters are described. Guiding catheter selection considerations and how to address issues like non-coaxial alignment are also summarized.
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
Rotational atherectomy is described in detail including vascular access, wiring, burr selection, technique, complications and their management. Key steps include using the smallest burr possible, short ablation runs under 20 seconds, and avoiding sudden drops in rotational speed to minimize complications. Complications can include slow-flow/no-reflow, dissection, perforation and burr entrapment. Prevention focuses on optimal technique and treatment involves reversing anticoagulation, vasodilators, balloons, stents or surgery depending on the complication.
1) The document discusses management of left main coronary artery (LMCA) disease, including definitions, data on medical management versus revascularization, and techniques for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
2) Registry and randomized controlled trial data show that PCI and CABG have similar outcomes for LMCA disease, with PCI having higher rates of repeat revascularization.
3) Intravascular ultrasound and fractional flow reserve can help assess intermediate LMCA stenosis and optimize stent placement and outcomes. Achieving adequate stent expansion is important for bifurcation lesions.
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
Guide catheters in coronary interventionRohitWalse2
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.
This document discusses left main coronary artery (LMCA) percutaneous coronary intervention (PCI). Key points:
1. LMCA disease can be treated with balloon angioplasty or stenting. Drug-eluting stents have reduced restenosis rates compared to bare-metal stents.
2. Assessment of LMCA lesions includes angiography as well as intravascular ultrasound (IVUS) and fractional flow reserve (FFR) to determine significance. An IVUS minimum luminal area <4.5mm2 or FFR<0.80 indicate a significant stenosis.
3. Techniques for stenting LMCA lesions depend on location and involve strategies like single crossover stenting or provisional two
This document discusses vascular closure devices (VCDs) that are used to achieve hemostasis after a cardiac catheterization procedure. It covers:
- The goals of VCDs including reducing time to hemostasis, bleeding, and allowing early patient ambulation.
- Types of VCDs including passive devices that augment natural clotting and active devices that mechanically close the artery.
- Examples of specific passive and active devices like Angioseal, Exoseal, and Manta.
- Studies showing VCDs reduce time to hemostasis and ambulation compared to manual compression.
- Tips for proper use of VCDs and potential complications.
1) Two-stent strategies can be used either as bail-out during provisional stenting if the side branch is compromised, or electively for complex bifurcation anatomies with predictors of side branch compromise.
2) Common two-stent techniques discussed include T/TAP stenting, mini-crush, culotte, and DK crush. Factors such as vessel diameters, angles, and lesion lengths help determine the appropriate technique.
3) Key steps discussed include optimal kissing balloon inflation, proximal optimization of the main vessel stent, and respecting the bifurcation anatomy. Being familiar with one or two techniques and using intravascular imaging is recommended.
This document provides an overview of approaches to chronic total occlusion percutaneous coronary intervention (CTO PCI). It defines CTOs and discusses their prevalence. Key points include:
- Success rates for CTO PCI are over 90% currently due to improved techniques and tools.
- Imaging like angiography, CT angiography, and IVUS help plan procedures by assessing lesion characteristics and collateral circulation.
- The retrograde approach and antegrade dissection and re-entry are common techniques in addition to the standard antegrade wire escalation method.
- Scoring systems like the J-CTO and W-CTO scores can predict difficulty and likelihood of success to help determine approach.
- Careful planning including
This document discusses pulmonary valve stenosis and balloon dilatation techniques. It provides background on the history and development of percutaneous pulmonary valvuloplasty. Key details include indications for the procedure, preprocedural evaluation and imaging, sedation and vascular access considerations, hemodynamic assessment, angiography, balloon catheter selection and use, and post-procedure protocol. The document serves as a reference for performing safe and effective balloon dilatation to treat pulmonary valve stenosis.
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021Hafeesh Fazulu
This document discusses rotablation, a technique for treating heavily calcified coronary lesions. It involves using a high-speed rotating burr to cut through calcium deposits. The burr ablates calcium into small particles that are carried away, allowing stent placement. Key points covered include:
- Rotablation differentially cuts calcium while sparing softer tissues
- Orthogonal friction from high-speed rotation allows passing the burr through tortuous segments
- It requires specialized equipment, guidewires, and catheters to position the burr and control its rotation
- Complications can include slow flow, perforation, or getting the burr lodged in the vessel
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
Coronary Artery Disease - HARDWARE IN CATH LAB.pptxgshah205
- Guidewires have a central core made of stainless steel or nitinol and a distal tip for visibility.
- Based on tip load, guidewires are classified as balanced, extra support, or floppy. Balanced guidewires are most commonly used.
- Guide catheters are used to support device advancement and injection of contrast. They have stiffer shafts and larger diameters than diagnostic catheters.
- Common guide catheters include Judkins, Amplatz, and extra backup guides which are selected based on aortic width and coronary anatomy.
The document discusses coronary guidewires, which are used to access and cross coronary lesions during angioplasty procedures. It provides a brief history of angioplasty and guidewire development. The key components and characteristics of guidewires are described in detail, including core material, tapering, tip design, coil placement, covers, coatings, and how these influence flexibility, torque, and other performance factors. Common guidewire classifications and specific guidewire models are also mentioned along with guidance on optimal guidewire positioning and potential complications.
This document discusses guiding catheters used in percutaneous coronary interventions. It describes the functions and structure of guiding catheters, including their layers, sizes, lengths and differences from diagnostic catheters. Factors that can cause dampening of arterial pressure are outlined. Techniques for shortening guiding catheters and various types of guiding catheters including Judkins and Amplatz catheters are described. Guiding catheter selection considerations and how to address issues like non-coaxial alignment are also summarized.
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
Rotational atherectomy is described in detail including vascular access, wiring, burr selection, technique, complications and their management. Key steps include using the smallest burr possible, short ablation runs under 20 seconds, and avoiding sudden drops in rotational speed to minimize complications. Complications can include slow-flow/no-reflow, dissection, perforation and burr entrapment. Prevention focuses on optimal technique and treatment involves reversing anticoagulation, vasodilators, balloons, stents or surgery depending on the complication.
1) The document discusses management of left main coronary artery (LMCA) disease, including definitions, data on medical management versus revascularization, and techniques for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
2) Registry and randomized controlled trial data show that PCI and CABG have similar outcomes for LMCA disease, with PCI having higher rates of repeat revascularization.
3) Intravascular ultrasound and fractional flow reserve can help assess intermediate LMCA stenosis and optimize stent placement and outcomes. Achieving adequate stent expansion is important for bifurcation lesions.
1) Guide catheter selection depends on factors like patient anatomy, access site, and complexity of the procedure.
2) Judkins and Amplatz catheters are commonly used for transfemoral cases while downsized versions and specialized catheters are used for transradial cases.
3) Characteristics like size, shape, curve, and support profile must be considered to provide coaxial engagement and backup support for device delivery.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
Guide catheters in coronary interventionRohitWalse2
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.
This document discusses left main coronary artery (LMCA) percutaneous coronary intervention (PCI). Key points:
1. LMCA disease can be treated with balloon angioplasty or stenting. Drug-eluting stents have reduced restenosis rates compared to bare-metal stents.
2. Assessment of LMCA lesions includes angiography as well as intravascular ultrasound (IVUS) and fractional flow reserve (FFR) to determine significance. An IVUS minimum luminal area <4.5mm2 or FFR<0.80 indicate a significant stenosis.
3. Techniques for stenting LMCA lesions depend on location and involve strategies like single crossover stenting or provisional two
This document discusses vascular closure devices (VCDs) that are used to achieve hemostasis after a cardiac catheterization procedure. It covers:
- The goals of VCDs including reducing time to hemostasis, bleeding, and allowing early patient ambulation.
- Types of VCDs including passive devices that augment natural clotting and active devices that mechanically close the artery.
- Examples of specific passive and active devices like Angioseal, Exoseal, and Manta.
- Studies showing VCDs reduce time to hemostasis and ambulation compared to manual compression.
- Tips for proper use of VCDs and potential complications.
1) Two-stent strategies can be used either as bail-out during provisional stenting if the side branch is compromised, or electively for complex bifurcation anatomies with predictors of side branch compromise.
2) Common two-stent techniques discussed include T/TAP stenting, mini-crush, culotte, and DK crush. Factors such as vessel diameters, angles, and lesion lengths help determine the appropriate technique.
3) Key steps discussed include optimal kissing balloon inflation, proximal optimization of the main vessel stent, and respecting the bifurcation anatomy. Being familiar with one or two techniques and using intravascular imaging is recommended.
This document provides an overview of approaches to chronic total occlusion percutaneous coronary intervention (CTO PCI). It defines CTOs and discusses their prevalence. Key points include:
- Success rates for CTO PCI are over 90% currently due to improved techniques and tools.
- Imaging like angiography, CT angiography, and IVUS help plan procedures by assessing lesion characteristics and collateral circulation.
- The retrograde approach and antegrade dissection and re-entry are common techniques in addition to the standard antegrade wire escalation method.
- Scoring systems like the J-CTO and W-CTO scores can predict difficulty and likelihood of success to help determine approach.
- Careful planning including
This document discusses pulmonary valve stenosis and balloon dilatation techniques. It provides background on the history and development of percutaneous pulmonary valvuloplasty. Key details include indications for the procedure, preprocedural evaluation and imaging, sedation and vascular access considerations, hemodynamic assessment, angiography, balloon catheter selection and use, and post-procedure protocol. The document serves as a reference for performing safe and effective balloon dilatation to treat pulmonary valve stenosis.
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
Rotablation - Dr Hafeesh Fazulu - PIMS May 5th 2021Hafeesh Fazulu
This document discusses rotablation, a technique for treating heavily calcified coronary lesions. It involves using a high-speed rotating burr to cut through calcium deposits. The burr ablates calcium into small particles that are carried away, allowing stent placement. Key points covered include:
- Rotablation differentially cuts calcium while sparing softer tissues
- Orthogonal friction from high-speed rotation allows passing the burr through tortuous segments
- It requires specialized equipment, guidewires, and catheters to position the burr and control its rotation
- Complications can include slow flow, perforation, or getting the burr lodged in the vessel
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.
Coronary Artery Disease - HARDWARE IN CATH LAB.pptxgshah205
- Guidewires have a central core made of stainless steel or nitinol and a distal tip for visibility.
- Based on tip load, guidewires are classified as balanced, extra support, or floppy. Balanced guidewires are most commonly used.
- Guide catheters are used to support device advancement and injection of contrast. They have stiffer shafts and larger diameters than diagnostic catheters.
- Common guide catheters include Judkins, Amplatz, and extra backup guides which are selected based on aortic width and coronary anatomy.
Guiding catheters are essential tools for PCI that provide support and allow delivery of devices to the coronary arteries. Selection involves considering factors like coronary anatomy, access site, and the procedure. The document discusses various catheter types including Judkins, Amplatz and extra support catheters. It also reviews tips for radial access PCI and techniques like using guide extensions or anchor balloons to support radial catheters. Proper catheter selection is important for achieving coaxial engagement and performing complex PCI procedures successfully.
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 document discusses different types of catheters used in cardiology, their characteristics, and appropriate uses. It begins by defining a catheter and its basic functions. It then covers topics like catheter size, characteristics related to pushability, torque, flexibility, and trackability. Specific features of guide catheters like preformed curves and lumen size are addressed. Differences between diagnostic and therapeutic catheters are highlighted. The roles of microcatheters in complex procedures are also summarized. Throughout, examples are given of catheter shapes, uses in different coronary anatomies, and selections for procedures like chronic total occlusions.
Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, noting that guide selection depends on factors like vessel anatomy and target location. It describes commonly used guide catheters like the Judkins, Amplatz, and EBU catheters, indicating their advantages and best applications. The document also reviews techniques like guide extensions and sheathless guides for improved support and tracking in difficult cases. Proper guide selection and positioning are emphasized for coaxial engagement and optimal backup support during interventions.
Difficulties in Transradial Intervention ( TRI).Ashok Dutta
Difficulties in transradial intervention include failure to puncture the radial artery, radial artery spasm, tortuosity or loops in the radial or brachial arteries, use of smaller catheters, difficult coronary cannulation, and challenges during percutaneous coronary intervention. Proper catheter selection based on artery size and anatomy, use of adjunct devices like buddy wires, and deep intubation can help maximize support during difficult cases. Angiography may be needed to guide wiring and balloon crossing in tortuous vessels, and stenting can seal aortic dissections involving the coronary ostium.
Rapid fire Tipps and Tricks – 5 min: What do do if …microcatheter cannot pass...Euro CTO Club
Rapid fire Tipps and Tricks – 5 min: What do do if …microcatheter cannot pass collateral
Jo Dens, Belgium
The Experts “Live” Workshop 2017
Saturday, September 16th, 2017
1) Guidewire technology has advanced significantly with a wide selection for different lesion characteristics and vessel anatomies.
2) Guidewires consist of a core material, taper, tip style, coils, and various coatings which determine properties like flexibility and trackability.
3) The choice of guidewire depends on factors like vessel anatomy, lesion morphology, and the intended procedure or device. Workhorse wires are preferred for simple lesions while more complex cases require dedicated wires.
This document discusses guidewire and balloon selection for percutaneous coronary interventions. It begins by outlining the functions of a guidewire, including safely accessing vessels, crossing lesions, and delivering devices without damage. It then covers guidewire design features such as core material, diameter, tip style and coils/covers which impact performance characteristics. Guidewires are classified based on tip load and intended uses are outlined. Balloon characteristics like profile, wrap, coating are reviewed. Specialty balloons for cutting, scoring plaques are described. Data is presented showing the benefits of post-dilatation after stent deployment.
This document discusses advanced tools and techniques for treating challenging coronary interventions, specifically chronic total occlusions (CTOs). It begins by outlining basic principles for CTO approach, including using bilateral access and maximum guide catheter backup. It then reviews equipment commonly used for CTO treatment like guidewires, balloons, and stents. Clinical challenges are discussed such as achieving guide catheter support and navigating complex anatomy. The document highlights guide extension techniques using devices like the GuideLiner which provides additional backup support. Case examples demonstrate using guide extensions and microcatheters to assist with complex CTO procedures. Microcatheter designs are reviewed for navigating tortuous vessels.
Coronary catheters are hollow flexible tubes used to diagnose and treat heart conditions. The first cardiac catheterization was performed in 1929 by Werner Forssmann who inserted a rubber catheter into his own antecubital vein up to his pulmonary artery. Ideal characteristics of coronary catheters include torque control, pushability, flexibility, trackability, radiopacity, and atraumatic tips. Catheter materials include polymers like dacron, nylon, PVC, polyethylene, fluoropolymers, and polyurethane. Guiding catheters have thinner shafts and larger internal diameters compared to diagnostic catheters.
PTCA, or percutaneous transluminal coronary angioplasty, involves inserting a balloon catheter into the heart through an artery to widen a narrowed coronary artery. The document discusses the hardware used in PTCA procedures, including introducer sheaths of varying sizes, guide wires of different tip flexibility, and balloon dilatation catheters made of compliant, semi-compliant, or non-compliant materials. It also covers intracoronary stents, describing their classification as either balloon expandable or self-expanding, composition, and important mechanical properties like elastic recoil and radial force.
This document provides an overview of basic equipment used in interventional radiology, including needles, wires, catheters, and sheaths. It describes the nomenclature and properties of different types of needles, wires, catheters, and sheaths. Examples are provided of how to select and use the appropriate equipment for common procedures like placing a Hickman catheter, draining an abdominal abscess, and accessing a renal calyx. Conversions between measurement systems for needle gauges, wire diameters, and catheter/sheath sizes are also reviewed.
This document discusses advanced techniques for treating coronary chronic total occlusions (CTOs), including the use of guide extensions. Guide extensions provide added support to guide catheters during challenging CTO interventions. They allow coaxial alignment of devices and improved deliverability. The document reviews several case examples where guide extensions facilitated retrograde wiring and reverse CART procedures. It also discusses sizing guide extensions and important factors to consider like vessel size, lesion location, and adjunctive tools.
Basic of PCI through Trans Radial RouteAshok Dutta
1. The document discusses the basics of percutaneous coronary intervention (PCI) through the transradial approach. It covers the history, access routes, procedural steps, guide catheter selection, complications and tips for successful PCI.
2. Key points include that the radial approach has a narrow pathway but fewer complications compared to the femoral approach. Guide catheter size selection depends on the vessel diameter and intended devices. Wiring, balloon angioplasty, stenting and post-dilatation are the standard steps of PCI.
3. Complications include dissection, perforation and stent malapposition. Tips provided to prevent complications and ensure procedural success include proper guide catheter and device selection, gentle manipulation, and frequent
This document discusses some of the difficulties that can arise during transradial intervention (TRI) and percutaneous coronary intervention (PCI) via the radial artery approach. It outlines potential challenges with radial artery puncture and anatomy, coronary cannulation, and using larger guide catheters for TRI compared to transfemoral intervention. The document also discusses strategies for managing difficult PCI situations like tortuous vessels, calcified lesions, bifurcation lesions, chronic total occlusions, and aorto-ostial dissections that may occur more commonly with TRI.
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This document summarizes the history and design evolution of shoulder arthroplasty. It discusses the three generations of humeral components from monoblocks to modular to anatomical designs. It also reviews glenoid component designs and fixation methods. Key points about the indications, surgical approaches, complications and outcomes of total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty are provided.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
7. Guiding catheter
• For each given size of, its ID is either a
standard, large or giant lumen
• Larger sizes –
– better opacification of the contrast
– better guide support
– allow pressure monitoring
increased risk of ostial trauma, vascular
complications and the possibility of kinking of
catheter shaft
8.
9.
10. Judkins and Amplatz
Judkins
• Extremely useful as a diagnostic cath - 1⁰ curve is
fixed
– Intubates small segment of ostium - ↓risk of trauma
• Limitation while performing PCI - 1⁰ curve is fixed
– May not be co-axial as cath makes an angle of ~90º
with cor - may be difficult to pass balloons-esp LCX
JL- point of contact on asc Ao -very high &
narrow- ↑ chance of prolapse & dislodgement
JR- no point of contact on asc Ao - extremely poor
support
11. Backup force
• 3 factors
– Catheter size
– Area of contact made by cath on Ao
– Angle (theta) of cath on the reverse side of Ao
• The angle (theta) determines the force that
can dislodge the guiding catheter.
12.
13. If this angle is ≈90⁰, it results in a
greater backup force. Therefore a
lower position is preferable as the
point of contact on the reverse side
of the aorta because the angle
approaches 90º
14.
15. Other Guiding Catheters
Long tip cath like Xtra backup (XB) & Extra back up (EBU)
• modifications for JL- stiffer & free 1⁰ curve
• more co-axial & ↑support
– XB distal tip - lies more horizontal within cor, sometimes
pointing ↑, & intubating more LMCA
– Longer segment of XB cath comes in contact with contra-
lat wall of Ao- ↑ back-up support
• XB cath- ~67% additional support v/s JR- at the cost of
↑ likelihood of trauma LMCA, esp - pre-existing plaque
• ↑stiffer - ↑chance of injury
XBLAD - ↑support for LAD interventions specifically
17. Guide Catheter for RCA Interventions
• JR or Hockey Stick (HS) is usually preferred
• Extra-support-(CTO/tortuous)- AL1
• MP cath- esp abn take-off, esp inf
• Three dimensional right curve (3 DRC) cath-
tortuous, bent anatomy & postr/supr take off
of RCA
• XBR & XBRCA -new caths specifically for inf &
sup take off of RCA respectively
18.
19. Guide Catheter for LCX Interventions
• JL 4 may be gently rotated clockwise to achieve a
stable co-axial alignment
• Ao root dialated / if JL 4 points anteriorly- JL 5
• If additional support –AL cath recommended
– Unlike JL, a simple withdrawal can cause the tip to
advance even furthe- best way to disengage an AL is
to advance it slightly→prolapse tip out of cor & then
rotate it out of the ostium
• Voda cath- esp when a double PTCA of LAD & LCX
in same sitting
21. Side Holes v/s No Side Holes
• Side holes
– where P gets freq damped (RCA)
– where prolonged intubation of cor mandated (CTO)
– to know P through out PCI (sole surviving art / LMCA)
• P will not be damped
• allow additnl blood flow out the tip- perfuse cor
• may also avoid catastrophic dissections in the ostium
of the artery if the guide catheter is not co-axial
it can be a false sense of security → Ao P, not cor P is
being monitored
suboptimal opacification
↓back up support- weak cath shaft & kinking at side
holes
22. Guide Techniques for PCI of Tortuous Arteries
Deep Seating of Guide
• cath deeply intubated into cor- ↑support
• RCA/LCX - clockwise rotation & gentle
advancing of guide over the guide wire
• LAD - counterclockwise rotation
↑ risk of dissection & embolization, esp
degenerated SVG
23. Guide Techniques for PCI of Tortuous Arteries
Child in Mother Technique
• 110cm long 5Fr guide (Child) in 100cm long
6Fr/7Fr guide catheter (Mother)
• May provide up-to 70% more support
• Trauma to vessel →dissection
• Air embolism usually occurring during
intubation of child catheter/during CAG
performed via mother guide
24. Shepard's Crook RCA
• Dramatic upturn with a ≈180º switchback turn
• AL1/0.75 & 3DRC are best suited for this
anatomy
25. Guide wire - construction
• Most - calibre of 0.014 inch
• Multi-layer constructions:
1. Core element (usually stainless steel/or nitinol): tapers
at variable points towards wire tip to impart differential
stiffness along wire's length
2. Terminal coil segment (often 30mm length; usually
radio-opaque material e.g. platinum/iridium alloys):
gives flexibility and allows wire tip to be shaped per
operator requirements
3. Coating: most wires – silicone/Teflon outer coating to
aid easy advancement. Some coated with a hydrophilic
polymer coating that becomes a gel when wet to reduce
surface friction and increase wire ‘slipperiness’
26. Guide wire - construction
• Most - calibre of 0.014 inch
• 3 main components of guidewire design:
– central core
– outer covering
– flexible distal tip
• The wire tip may be further subdivided into
spring coil & short distal tip weld
• Also, all guidewires have a specific surface
coating applied
27. Central core
• Longest & stiffest portion of guidewire
• Tapers distally to a variable extent
– 2-piece core- distal part of core does not reach
distal tip of wire→ shaping ribbon, extends to
distal tip
– 1-piece core- tapered core reaches distal tip weld
• 2-piece →easy shaping & durable shape
memory
• 1-piece →better force transmission to tip &
greater “tactile response” for operator
28.
29. Central core
• Stainless steel
– superior torque characteristics, can deliver more
push, provides good shapeability of tip in core-to-tip
design wires
– more susceptible to kinking
• Durasteel- better tip shape retention and
durability
• Nitinol
– pliable but supportive, less torquability than SS
– generally considered kink resistant & have a tendency
to return to their original shape, making them
potentially less susceptible to deformation during
prolonged use
30. Distal tip
• Flexible, radio-opaque part
• Consists of spring coil extending from distal
untapered part of central core to distal tip weld
• Integrates tapered core barrel (as well as shaping
ribbon in 2-piece wire)
• Spring coil-variable length (1-25cm)-radio-opaque
section located at its terminal end
• Distal tip weld- short (≤2mm)compact cap
forming the true distal end of the wire - to ↓
trauma while the wire is traversing vessels
31.
32. Wire Coating-hydrophilic/hydrophobic
Hydrophobic
• Repels water - requires no actuation/wetting
• ↓friction (to ½ V/S no coating), ↑trackability
• Preserves tactile feel, allows easier
anchorability / parking - esp CTO
• Silicone, Teflon
33. Hydrophilic
• Attracts water - needs lubrication
• Thin, slippery, non-solid when dry→ becomes a gel when
wet
– ↓friction(⅙ no coating) →glide through tortuous
– ↑trackability
– ↓Thrombogenic
↓tactile feel- ↑risk of perforation
Tendency to stick to angioplasty cath
• Useful in negotiating tortuous lesions and in “finding
microchannels” in total occlusions
• Lubricity is highest with hydrophilic wires, less with
Silicone coating and least with PTFE or Teflon coating
34. Properties Of An Ideal Guidewire
• Push transmission/steerability
• Torque transmission/torquability
• Body support/ trackability
• Tip support/mobility
• Flexibility
• Tip durability/elasticity
• Tip visibility and markers
• Tactile feedback
• Prolapse tendency
35. • Push transmission/steerability: ability of a guide wire tip to be delivered to
the desired position in a vessel
• Torque transmission: ability to transmit rotational forces from the
operators hand to the tip
• Body support/ trackability: ability to advance balloon catheters/other
devices on guidewire
• Tip support/mobility: Allows moving the distal tip to search for the true
lumen
• Tip durability/elasticity: Permits shape memory retention of the distal tip
throughout
• Tactile feedback: “feel” of the wire tip’s behavior, as perceived by the
operator
– better appreciated with non-coated / hydrophobic coated, coil tipped wires and
it ↓with hydrophilic coating
36.
37. Shapeability and shaping memory
• Shapeability - allows to modify its distal tip
conformation
• Shaping memory - ability of tip to return back to
its basal conformation after having been exposed
to deformation & stress
– Both do not necessarily go in parallel
– SS core wires -easier to shape (↑memory- nitinol
core)
– 2-piece core + shaping ribbon - easier to shape &
↑memory
• General rule- when negotiating a vessel with J
loop, distal bend ~ D of vessel—more bend -
↑wire tip prolapsing, less bend -↓ steerability
38. Types Of Guidewires
• Depending on tip load- Balanced, Extra
support, Floppy
• Tip load- force needed to bend a wire when
exerted on a straight guide wire tip, at 1 cm
from the tip
– Balanced – 0.5-0.9g
– Extra support - >0.9g
– Floppy - <0.5g
39. • Workhorse wire: default choice - balance btw
stiffness/support & flexible tip – majority
lesions
• Stiff wires: offer extra support for
tortuous/calcified cor
• Floppy wires: when vessel trauma is a concern
(e.g. re-crossing a dissected lesion)
40. Workhorse (frontline) Guidewires
• ATW/ATW Marker
• Stabilizer
• BMW / BMW Universal
• Zinger
• Cougar XT
• Asahi Light / Medium
• Asahi Standard
• Asahi Prowater Flex
• Choice Floppy
• Luge
• IQ
• Forte Floppy
• Runthrough NS
• Galeo
41. Balance Middleweight Universal wire
(Abbott Vascular/Guidant, Santa Clara, CA)
• Quite steerable - tip is suitable for bending in a “J”
configuration for distal advancement into the distal vessel
bed with minimal trauma while still maintaining some
torque
• shape retention relatively poor -any J configuration tends to
become magnified over time → consequent loss in
steerability
• moderately torquable- progression - minimal friction (light
hydrophilic coating) - Dye injection may also be helpful to
propagate distal advancement
• suitable for rapid, uncomplicated interventions
• low risk to cause dissections/distal perforations
• support - low to moderate
42. Balance Middleweight wires
• from the generation previous to the Universal
• lack light hydrophilic coating at the tip→ more
steerability but requires greater effort for
distal advancement
• more direct tactile feedback (v/s more
automatic progression –Universal)
• Support-moderate
-power steering-
43. Runthrough NS® wire
• unique dual core design
– main shaft core of SS & a distal core of nitinol
alloy, which extends into a nitinol shaping ribbon
• distal tip is hydrophilic coated
45. Guidewire Strategies for Approaching CTO
• A) Guidewires for
Approaching Micro-channels
– Crosswire NT
– Whisper / Pilot
– Rinato
– Shinobe / Shinobe Plus
– ChoICE PT / ChoICE PT ES
– PT Graphix
– PT2
• B) Guidewires for Drilling
Strategy
– Persuader
– Miracle Bros
– Cross-It
• C) Guidewires for Penetrating
Strategy
– Cross IT
– Conquest Pro
– Liber 8
• D) Guidewires for Retrograde
Technique
– Fielder/FielderFC
– X -treme
– Whisper
– ChoICE PT2
– Runthrough / Runthrough
Hypercoat
46. CTO
• Start with the intermediate wire
• This provides 3g of distal force and moderate
support
• Conventional stainless steel core wire with
30mm of tip radio-opacity and 0.014 in.
diameter
• If this wire fails to cross, → Miracle series
47. Intermediate Wire (Asahi Intecc)
• ●Tip load ............................... 3.0 g
• ●Tip radiopacity .................... 3 cm
• ●PTFE coating over the shaft
48. Miracle series (Asahi Intecc)
• 0.014 in wires - specifically designed for CTO
• 110mm of distal tip radio-opacity for optimal
visualization
• Come in 4 versions of ↑ distal force:
3g, 4.5g, 6g, 12g
53. Conquest series (Asahi Intecc)
• The next evolution- tapered tip Conquest wire (Confianza)
– Has a distal tip diameter of only 0.009 in
– The distal tip is radio-opaque for 200mm
– Provides 9g of distal force
• Conquest Pro (Confianza Pro)
– Also tapered to 0.009 in
– Provides 9g of force
– Hydrophilic-coated for the distal 20 cm
Tip tapering is proposed to help the wire find and navigate
microchannels in the occluded segment, while the hydrophilic
coating of the Conquest Pro reduces the tip friction by about one-
third
54. ●Tip load ............................... 9.0 g
●Tip radiopacity .................. 20 cm
●Tip outer diameter ...... 0.009 inch (0.23 mm)
●PTFE coating over the shaft
55. ●Tip load ............................... 9.0 g
●Tip radiopacity .................. 20 cm
●Tip outer diameter ...... 0.009 inch (0.23 mm)
●SLIP COAT coating over the spring coil
●PTFE coating over the shaft
The distal tip is not coated to allow it to catch on
the entry point of the lesions
56. ●Tip load ............................. 12.0 g
●Tip radiopacity .................. 20 cm
●Tip outer diameter ...... 0.009 inch
●SLIP COAT® coating over the spring coil
●PTFE coating over the shaft
For penetration of calcification and proximal
or distal thick, fibrous caps
57. ●Tip load ............................. 22.0 g
●Tip radiopacity .................. 17 cm
●Tip outer diameter ...... 0.008 inch (0.20 mm)
●SLIP COAT® coating over the spring coil
●PTFE coating over the shaft
Designed for crossing complex lesions with heavy
calcifications and tough fibrous tissues
Finest and stiffest guidewire in the current Asahi
series.
58. Fielder™ / Fielder FC™ (Asahi Intec Co.)
• Special guidewire - distal coil coated with
polymer sleeve & further coated with a
hydrophilic coating
• Provides advanced slip performance &
trackability for highly stenosed lesion & tortuous
vessels
• Very good torque performance
• Combines both slide and torque performance
• Primary wire used in the retrograde technique of
recanalization of CTO
59. Tip load ............................... 1.0 g
Tip radiopacity .................... 3 cm
Polymer sleeve length ..... 22 cm
SLIP COAT coating over the spring coil
PTFE coating over the shaft
60. ●Tip load ............................... 0.8 g
●Tip radiopacity .................... 3 cm
●Polymer sleeve length ..... 20 cm
●SLIP COAT coating over the spring coil
●PTFE coating over the shaft
61. ●Tip load ............................... 0.8 g
●Tip radiopacity .................. 16 cm
●Polymer sleeve length ..... 16 cm
●Tip outer diameter ...... 0.009 inch(0.23 mm)
●SLIP COAT® coating over the spring coil
●PTFE coating over the shaft
65. Optimum guide wire positioning
• Should be placed as distally as possible in the
target vessel
• Allows extra support when crossing with
balloon/stent catheters
• ↓ chance of the wire becoming displaced
backwards across the lesion and necessitating
re-crossing
Avoid vessel perforation when positioning
wires with hydrophilic coatings very distally
66. Plain ‘old’ balloon angioplasty
• 1977- Andreas Gruentzig
• 1st gen balloon cath - fixed to guidewire - difficult
to cross tight/tortuous lesions
• Initially, over-the-wire systems → new monorail
systems
– Short guidewires
– Facilitates performance of PTCA by a single operator
• Progression in balloon technology
– different type, better materials, better coatings,
lower-profile systems, improved delivery, ↑burst
pressure, ↓compliance
68. Construction of the balloon catheter
(monorail type)
Only the distal 15–25 cm of the balloon catheter tracks over the guidewire
1. less procedural time
2. a single operator
3. reduced fluoroscopy time
4. no additional devices for the exchange
69. The catheter has a lumen through its entire length that tracks over a guidewire
Guidewire and balloon catheter move independently of each other
1. two operators
2. can exchange balloon catheters only with a 300 cm exchange length wire or specific
products (Trapper or Magnet) in order to maintain the wire position across the lesion
3. increased exposure to radiation because the fluoroscopy needs to be on during the
placement of the balloon
70. The guidewire and balloon are on the system
1. The guidewire cannot be advanced independently over the Balloon
2. Fixed system- does not allow for guidewire exchange
3. Has the lowest profile
4. Inability to exchange for another balloon catheter without having to recross the lesion
5. Need to remove the whole system if the wire tip becomes damaged
71. Either an over-the-wire or a monorail design
Perfusion side holes proximal and distal to the actual balloon
As the balloon is inflated, the perfusion side holes allow blood to enter the catheter through the
proximal holes, flow within the inflated balloon, and exit the catheter’s distal side holes
•Balloon can be inflated for longer periods of time
•Specific situations- cor perforation & abrupt closure, that cannot be recovered by a stent
•Decreased trackability due to its larger diameter
72. Balloons
Distal tip -usually tapered- allows to cross lesion
less traumatically
• Profile of the distal tip will determine how
much push is needed to get across the lesion
• Coating – also determinant for ability to cross
– A hydrophilic coating- superior in crossabilty
– A slippery characteristic- not suitable for in-stent
restenosis- balloon will easily slip out of the lesion
when inflated
73. Performance Parameters
• Low entry & crossing profile- for optimum
tracking & crossing
• Short inflation & deflation time- to avoid
ischemic complications
• Optimum refolding characteristics- to avoid
traumatization or stent damage
• Predictable balloon compliance- to allow precise
diameter sizing
• High balloon-burst strength- for high-pressure
dilatations
• Low bending stiffness- for easy tracking of curved
vessels
74. Profile
• Largest diameter in the balloon region
– To position balloon safely across tight lesions,
↓possible profiles required
– To cross extremely tight & long lesions, both entry
& crossing profiles must be ↓
– ↓profiles -to avoid luminal obstructions
75. Maximum Profile of PTCA Balloon Catheters
Distal profile
(mm)
Proximal profile
(mm)
Medtronic
Sprinter 3.0/20
mm
0.85 1.00
Biotronik Elect
3.0/20 mm 0.85 1.00
Guidant Voyager
3.0/20 mm 0.80 0.95
Boston Scientific
Maverick23.0/20
mm
0.85 0.95
Cordis AquaT3
3.0/20 mm 0.80 0.95
76. Inflation & Deflation Time
• Inflation of a balloon within a narrowed, but
not completely occluded, blood vessel results
in ischemia of the dependent tissue
• To ↓ ischemic time - ↓ obstruction time
• Obstruction time =time required to transmit
pressure in the hand pump to the balloon +
time for balloon inflation + deflation time
77. • Resistance,R- determined by viscosity, inner
radius r & length l of the hypotube
• Poiseuille's law
– So r of the tubing- major determinant of resistance
– Low-caliber - long inflation/deflation time→limit on ↓
catheter shaft profiles
– Inflation & deflation times depend on volume of
balloon- not useful in balloon comparisons
• For balloon inflation, a clinically relevant mixture
of saline & contrast agent (1:1) should be used
78. • Deflated balloon remains within lumen &
obstructs blood flow
• To minimize residual obstruction & to avoid
vessel damage by “flaring”•
of unfolded balloon
parts on retraction, the geometric refolding
characteristics of balloon after deployment-
important
• ↓cross-sectional area & smooth profile of
refolded balloon - least blood-flow obstruction,
avoids vessel traumatization, stent damage on
withdrawal
80. Balloon Compliance
• Change in balloon D for a given change in
balloon P
• Can be either indicated as a %↑in D/bar, or
listed as a table of P & corresponding balloon
D- 1st useful for classification of balloons as
noncompliant/semicompliant, latter is usually
given by the manufacturer for each device as
the compliance chart
81. High to moderate compliance balloons
• Polyolefin copolymer (POC)
• Polyethylene (PE) [< than POC]
Balloon sizing important – oversizing can easily
occur
Tend not only to stretch in D but also to
overexpand into the areas of least resistance, i.e.
prox & distal to lesion –(‘dog-boning’)- dissection
observed more commonly
Crossability may be superior
83. Non complaint balloons
• Polyethylene terephthalate (PET)
thicker-walled balloon
Allow work at higher pressures
hard calcified lesion or post-stent dilatation
84. (a) A compliant balloon tends to be oversized at the edges, with less
dilatation at the obstructive segment of the lesion (‘dog-boning’)
(b) A noncompliant balloon gives a predictable amount of pressure at the
lesion without uncontrolled radial and longitudinal growth
85. D Compliance of High-pressure PTCA Balloons
Diameter compliance
(%/bar)
Medtronic Sprinter
3.0/20 mm
9.92
Biotronik Elect 3.0/20
mm
5.50
Guidant Voyager 3.0/20
mm
8.99
Boston Scientific
Maverick23.0/20 mm
9.88
Cordis AquaT3 3.0/20
mm
5.88
86. Balloon Burst Strength
• The radial & axial stresses (σrad, σax) depend on
balloon pressure p, balloon diameter d, &
thickness s of balloon wall
– Balloon will burst if stresses exceed rupture stress of
the material
– Stress- linear correlation with P & D, and inverse
relationship to balloon thickness
– Given the same material, a larger balloon diameter &
thin balloon material →↓burst P
– Also within the balloon axial stress is ½ as big as radial
stress
87. • RBP→ the maximum recommended P for safe
use - 99.9% of the tested balloons will not fail
at RBP with 95% confidence
• Nominal P→ the P at which balloon will have
expanded to the manufacturer-specified size
– e.g. a 2.5mm D balloon expanded to nominal P
should have an external diameter of 2.5mm
88. The dilating force
• Pressure (hydrostatic force) put in the balloon
• Tension determined by
– balloon diameter,
– balloon material/compliancy, and
– vector force (the amount of constriction)
• Therefore, balloon size and balloon
compliance are the major determinants for
successful mechanical dilatation
89. In IVUS , dissection is observed in up to 60–70% of dilated segments
Dissection may be necessary for optimal results after POBA
90. • Long lesions(>20mm)- may be treated with
long balloon to avoid dissection at edges
• Soft lesions(recent)-↑lipid conc-↓inflation P
• Calcified lesions(cholesterol, conn tissue,&
muscle cells)-↑dissection/perforation chance
-NC balloon-allows ↑inflation P to crack lesion
• Calcified lesions & post stent dilatation-
↑rated burst P & shorter balloons better
• Size of balloon- based on ref vessel D -
balloon/artery ratio of ~ 1.1 currently recom
91. • Trackability
– ability of a system to be advanced to a target lesion
– affected by several technical parameters such as
friction, bending stiffness etc
• Crossability
– ability to pass stenoses
• Pushability
– load transfer from interventionist‘s end to the distal
tip of catheter High load transfer allows finer & more
direct tactile control of the instrumentation
• Even small obstructions that cause only a minor ↑ in
reaction forces at the catheter tip can be felt by the
operator, allowing him to tune and finely adjust the pushing
force to overcome the obstacle while utilizing the least
injurious maneuver
92. Crossing Difficult Lesions
Following techniques
• use of stronger back-up catheters
• deep insertion of guide
• adding vibration
• Pushing balloon while pulling guidewire
• use of a stiff guidewire
• Buddy wire technique
97. Jocath Mercury PTCA Catheter
Balloon Compliance: Semi-compliant
Shaft Diameter: 2.0F proximal
2.7F distal
Shaft length: 140-145 cm
Lesion Entry Profile: 0.017"
Nominal Pressure: 8 bar
Rated Burst Pressure: 16 bar
Average Burst Pressure: 22 bar
Coating: HYDREX Coating System
Min. Guiding Catheter: 5F (0.058")
98. NC Mercury PTCA Catheter
• Maximized wall apposition due to NC balloon
behavior
• Minimal balloon overhang- to limit vessel
injury during high P dilatation
• Minimal tip flaring
• Fast deflation time
• Efficient access- low entry profile
100. • Ulrich Sigwart & Joel Puel in 1987 implanted
the first stent in a human coronary artery in
Toulouse, France
101. TYPES OF STENTS
• Metal composition
• Open v/s closed cell designs
• Thickness of struts
• Eluting drugs
• Stent design may be specific -small (<2.5 mm
diameter) vessels / bifurcation lesions
102. Metal composition
• Cobalt-chromium - more deliverable for
challenging lesions
• Stainless steel designs - greater radial strength
for bulky lesions or those involving more
muscular aorto-ostial locations
• Co-Cr - stronger & more radiopaque than SS
→ thinner struts, lower profiles (<0.40”),
better flexibility & similar radial strength
104. Slotted tube stents
• Slotted tube stents are made just by cutting
longitudinal slashes in tubes
105. Modular stents
• Consist of several crown-shaped modules,
which may be manufactured from metal wires
that are punctually connected to form a tube
– ie, based on repeating identically designed units,
again laser-cut, linked together by welded struts
• An ‘open-cell’ design
• Highly flexible
• Offer better side-branch access
– Boston Scientific Express stent
106. • Open-cell/modular stent design
• Multiple repeating modules are linked at
certain points of the design, giving flexibility
but less metal : artery coverage
• Medtronic DriverTM stent
109. • Closed-cell stent design
• Modern closed-cell stents have relatively large
cells
• Boston LiberteTM stent
110. Modular-multicellular stent
• Also called hybrid stents
• Try to combine the advantages of multicellular
and modular stents
– Lekton Motion, Pro Kinetic
111. Cell design
Closed cell (in which each ring is interconnected)
• more support
less flexible
Open cell
• improves flexibility
• improves sidebranch access
reduce radial support
112. • Strut- single element that forms larger structural
entities such as cells, rings, or crowns
• Cell - small but regularly repetitive structure of a
stent
– Open cells have a more complicated structure than
closed cells
– Cells represent the elementary geometrical figure of
the stent- will deform during stent expansion
• Rings and crowns- comprise a cluster of cells
forming a higher-order geometrical pattern of the
stent, which may form complete stent segments
usually coupled by longitudinal bridges or links
114. Stent coating
• The eluted drug is linked by a
degradable/permanent polymer coating only
a few micrometers in thickness
– not expected to change mechanical strength
– may affect surface friction
115. • Provides local delivery of a drug
• Methods for the storage and controlled release
– Nondegradable or biodegradable polymer
– Cavities on the stent struts- drug depots
– Small amounts of drugs applied directly to stent surface
• Nondegradable polymers- polyurethane, silicone,
polyorganophosphazene, polymethacrylate,
poly(ethylene terephthalate), & phosphorylcholine
• Biodegradable polymer- poly(l-lactide), poly(3-
hydroxybutyrate), polycaprolactone, polyorthoester,
fibrin
116. DES- mechanism of benefit
• Late lumen loss and restenosis after nonstent interv -
combination of acute recoil, negative remodeling
(arterial contraction), and local neointimal hyperplasia
• Late lumen loss after stenting - solely to in-stent
neointimal hyperplasia
• The restenosis benefit of DES compared to BMS results
from inhibition of in-stent neointimal hyperplasia ,
which is reflected as a lesser degree of late in-stent
lumen loss at 6-9/12 (0.2 to 0.4 versus 0.9 to 1.0 mm
with BMS) -Neointimal suppression is still sustained at
2years
117. • In the Ontario registry the benefit was limited
to those patients with two or three risk factors
for restenosis (diabetes, vessels <3 mm in
diameter, and lesions ≥ 20 mm in length)
• In the Swedish Coronary Angiography and
Angioplasty Registry (SCAAR), the benefit with
DES compared with BMS was most apparent
when any one of these high risk features was
present
118. Sirolimus
• aka Rapamycin- immunosuppressant drug - macrolide
• First discovered from Streptomyces hygroscopicus in
Easter island soil sample— island aka "Rapa Nui",
hence named
• Originally developed as an anti-fungal agent
• Sirolimus is lipophilic - crosses cell membranes – binds
FK binding protein-12 (FKBP-12)→an active complex
• Sirolimus:FKBP-12 complex→binds & inhibits
mammalian Target Of Rapamycin (TOR)
• Inhibition of this enzyme→↓cytokine-dependent
cellular proliferation at G1 to S phase of cell cycle
• The mechanism of inhibition is cytostatic rather than
cytotoxic as the affected cells remain viable
119. Paclitaxel
• Mitotic inhibitor isolated it from bark of
the Pacific yew tree, Taxus brevifolia, hence
named taxol
• Stabilizes microtubules→ interferes with the N
breakdown of microtubules during cell
division→prevents DNA synth
• Paclitaxel-inhibited cells remain at the G0/G1 and
G2/M interfaces of the cell cycle
• Cells exposed to paclitaxel undergo apoptosis/cell
death- cytotoxic
121. Everolimus
• A rapamycin analogue
• Novel macrolide with potent
immunosuppressive & antiproliferative effect
• Arrests cell cycle at the G1 to S phase
122. Biodegradable stents
• Intended to support a vessel for just as long as is
necessary to complete the healing process and
to then disappear after a specified time period
• Complications resulting from long-term
intravascular presence of a FB- thrombogenicity,
permanent mechanical irritation, prevention of
positive remodeling, are eliminated
• Poly(L-lactic acid) (PLLA), poly(D-lactic acid)
(PDLA), poly(e-caprolactone) (PCL), poly(glycolic
acid) (PGA)
124. NexgenTM Cobalt Chromium Coronary Stent System
• Hybrid cell design
• Ultra-low strut thickness of 65µm
• The balloon overhang is 0.3mm ensuring that
balloon related injury is marginalized
128. Lekton Motion
• Combines cell pattern & Z-shaped connections
• Strut thickness of 90µm
• Ultra low profile (<1.00mm) permits excellent
tracking & crossing
• Also available in 2 versions: Petite (vessels
<2.5mm) & Mega (vessels >4mm)
129. • Petite
– 80 µm struts
– Small vessel design with lowest crossing profile
– Shaft with Enhanced Force Transmission
technology permits exellent positionning in distal
anatomy
• Mega
– Compatible with 5F guide catheters in all sizes
– Special design for optimal flexibility and support
of large vessels (>4mm)
– Maximum expansion: 5.5 mm
130. PRO-Kinetic
• Cobalt Chromium Stents
• Struts- 60 µm (0.0024“)
• 3 Different Design
– Specific designs for small, medium and large arteries
• Low Profile
– Low profile (0.95 mm) permits easy track & cross
• Double Enhanced Force Transmission Shaft (EFT)
– ↑shaft flexibility & kink resistance
• Hydroglide coating
• ↓Shaft Profile- all sizes compatible with 5F space
stents
132. genXsync
• Uniform sinus design
• Alternate ‘S’ link offers excellent flexibility
• Biodegradable polymer in single layer→initial
burst of sirolimus followed by sustained elution up
to 40 days
• Polymer degrades by hydrolysis & enzymatic
→excreted in form of CO2 & H20
• PTFE hypotubing shaft- improved pushability
• Super thin alloy (65µm) with ultra thin coating
(3µm)
• Low crossing profile drug eluting stent (< 0.85 mm)
133. Stent material L 605 Chromium Cobalt
Design
Uniform sinusoidal cell
design
Coating
Bioresorbable and
biodegradable polymers
Drug Sirolimus
Strut thickness 65 µm
Strut width 85 µm
Nominal foreshortening Nearly zero
Recoil < 4.0%
Guiding Catheter 5 Fr Compatible
Crossing Profile < 0.85 mm
134. CYPHER® Stent
Stent Geometry Closed-cell FLEXSEGMENT™
Technology
Material 316L Stainless Steel
Strut Thickness .0055"
Crimped Profile .044"
Available Sizes
Diameters: 2.25, 2.50, 2.75,
3.00, 3.50 mm
Lengths: 8, 13, 18,23, 28, 33 mm
Drug Delivered Sirolimus
Mechanism of Action
Inhibits m TOR to block growth
factor induce proliferation
Cytostatic
Drug Delivery Vehicle Controlled-release,
nonresorbable,
elastomeric polymer coating
Drug Release Kinetics
80% of sirolimus released in 30
days
Approval Status Approved by FDA
139. • Attempts to ↓ the amount of balloon
protrusion outside the stent →↓vessel
trauma in adjacent cor segs
• A perfect match not yet achieved
• Diffuse disease- Minimal balloon overhand
• Significant vessel tapering- Minimal balloon
overhand
140. A = plaque compression
B = superficial tear/fissure
(intimal)
C = deeper sub-intimal
tear
D = subintimal tear with
localized dissection
E = deep subintimal tear
with extensive dissection
reaching media
F = circular sub-intimal
dissection
In eccentric lesions,
stretching of vessel wall
(without plaque)
and sub-medial dissection
can occur
141. Vessel size
• In the beginning - elective stent deployment
limited to large cor (≥ 3 mm)
• STRESS trial →elective stenting provided
superior angiographic & clinical outcomes in
vessels <3 mm (stented using 3 mm stents)
142.
143. Optimal stenting
• Deployment with only minimal residual
luminal stenosis -↓risk of both ST & ISR
• Suboptimal luminal dilation
– inadequate balloon expansion (related in part to
plaque characteristics) &
– elastic recoil ( asso with stent design & resistance)
144. • STARS→ 265 (13.5%) of 1,965 pts enrolled met
prespecified criteria for suboptimal stenting
• (defined as residual stenosis >10 percent,
evidence of stent thrombosis, dissection or
abrupt closure, absence of TIMI III flow, or
need for three or more stents)
Acute and nine-month clinical outcomes after "suboptimal" coronary stenting: results from the
STent Anti-thrombotic Regimen Study (STARS) registry J Am Coll Cardiol 1999 Sep;34(3):698-706.
145. Suboptimal stenting
• ↑periprocedural NSTEMI (8.7 v/s 4.2 %)
• ↑overall 30 day mortality (1.1 v/s 0.06 %)
• ↑clinical restenosis (27 v/s 16 %)
• ↑ 9/12 MACE(death,MI,TVR), esp due to
↑NSTEMI(9 v/s 4.6 %) & TVR(15.5 v/s 10.2 %)
Acute and nine-month clinical outcomes after "suboptimal" coronary stenting: results from the
STent Anti-thrombotic Regimen Study (STARS) registry J Am Coll Cardiol 1999 Sep;34(3):698-706.
146. Role of predilation
classic approach
• Predilation→ stent deployment→ high-P
postdilation
– ↑procedure time
– ↑radiation exposure
– ↑contrast use
– ↑cost
147. • Tight/heavily calcified lesions, esp in tortuous
vessels→ ↑risk of stent dislodgement from
delivery balloon & potential embolization of
the stent
• Predilatation – also preferred when precise
positioning of distal end of the stent is
mandatory- potentially poor visualization of
the vessel distal to the stent may occur,
particularly in critical stenoses
148. Direct stenting
• Theoretically less traumatic to vessel wall
May be esp beneficial in the presence of
thrombus/when treating degenerated SVG
• Direct stenting →↓ procedure time, ↓contrast
• Prox anat landmark- side branch/Ca spot, to guide
stent positioning - helpful during direct stenting
• Use of extra support guidewires & optimal cath
support recommended
149. • Settings in which direct stenting might be
considered
– Vessel ≥ 2.5 mm
– Absence of severe cor Ca
– Absence of signi angulation (>45º)
– Absence of occlusions & bifurcations
150. Direct stenting
Potential Advantages Potential Drawbacks
Avoidance of multiple
exchanges
Failure to track
Less trauma Failure of precise
positioning, incomplete
deployment
Lower rate of “no-
reflow”•
Stent damage or loss
Shorter procedural time Incomplete apposition
Lower procedural costs Traumatization of the
target vessel
151. (BET, SWIBAP, PREDICT, CONVERTIBLE, and TRENDS)
• Major outcomes – similar
(proc success, adv events, MACE)
• Direct stenting for CSA- asso with
↓periprocedural microcirculatory injury v/s
pre-dilation -50 pts - J Am Coll Cardiol. 2008
Mar 18;51(11):1060-5
152. STEMI undergoing PPCI → ↓embolization of plaque
constituents, ↓no-reflow →↑myo perfusion &
salvage
• A randomized comparison DS v/s Conv-( J Am Coll
Cardiol 2002 Jan 2;39(1):15-21) - 206 pts- 102/104-
– Composite end point of slow & no-
reflow/embolization- (DS-11.7% vs. 26.9%, p = 0.01)
– No ST resolution in 20.2% (DS) vs. 38.1%, p = 0.01
• STEMI-Angio & clinical outcomes asso with direct
v/s conv in pts treated with lytic therapy –( Am J
Cardiol 2005 Feb 1;95(3):383-6) - Direct stenting -↓death,
MI, or CCF during hosp & at 30 days -
independently asso with ↑ in-hospital outcomes
153. Spot stenting
• Using the shortest possible stent only in the particular
segments of a lesion - proposed by Colombo &
colleagues
– Attractive strategy, given the poor outcomes of long
lesions treated with very long (>32 mm) stents
• Clinical events & TLR ↓in spot stenting gp than in
conven (22% v/s 38% & 19% v/s 34%, resp)- Colombo A, De
Gregorio J, Moussa I, et al: J Am Coll Cardiol 2001; 38:1427–33.
• Use of long stents to treat vessels >3.5 mm in diameter
provides acceptable restenosis rates, whereas
minimizing stent length is important in small vessels
154. Role of high pressure balloon dilation
High (16 to 20 atm) & low (8 to 10 atm)
• Stents usually deployed with a high P
technique utilizing ≥ 12 to 16 atm
• Lower P deployment (8 to 14 atm) -signi vessel
tapering/when prox edge injury is a concern,
as is the case with use of drug-eluting stents
• Most cases- high-pressure postdilation with an
appropriately sized NC balloon at 12 to 16 atm
to achieve full stent expansion
155. Hospital discharge
• Patients undergoing elective stenting are
generally discharged within 24 hours after
stent implantation following overnight
observation and monitoring
156. EPOS trial
• 800 pts elective PCI
• Same-day discharge (after 4hrs of bed rest & 4hrs of ambulation) V/S
overnight stay
• Femoral approach with 5F or 6F guiding catheters, pretreatment with
100mg of asa, single 5000 IU hep, 300mg clopi post procedure in pts who
were stented
• 80%- eligible for same-day discharge in both gps
• Suitability criteria for early discharge -freedom from sympts & absence of
ECG changes & puncture site abn
• Same-day discharge after elective PCI is feasible and safe in the majority
(80%) of patients selected for day-case PCI. Same-day discharge does not
lead to additional complications compared with overnight stay
• Limitations- postprocedural rather than preprocedural clopi; no use of
bivalirudin or glycoprotein IIb/IIIa inhibitors; small catheter sizes and
elective admission for PCI rather than PCI directly following angiography
Heyde GS; Koch KT et al. Circulation. 2007 May 1;115(17):2299-306
157. SAFETY OF MRI
• Based upon available evidence, it appears to
be safe to perform an MRI at any time after
placement of coronary artery stents of any
type
Editor's Notes
Guiding catheters are generally composed of 3 layers. The outer layer consists of either polyurethane or polyethylene for overall stiffness. The middle layer is composed of a wire matrix for torque generation and the inner coating is composed of Teflon for smooth passage of balloon catheter
). It has generally three curves responsible for its overall unique configuration
With Judkins catheter the point of contact is narrow and higher on the aorta contributing to weak back up support. On the other hand with Amplatz Left (AL) type of catheter, base of sweeping secondary curve is intended to rest on the aortic root, providing for additional back-up support. However, this same property makes it prone to dissect the ostium of intubated artery
Central core is the basic component of the guidewire. It contributes to the trackability, torqueability and push transmission of the interventional device. The greater is the strength of the material constituting the central core and the greater its thickness, the greater the torqueability and body support provided by it. Stainless steel contributes to more pushability, torqueability and good shape ability, but itis less flexible than newer core materials like Nitinol and also has a tendency to kink. Super-elastic alloy like Nitinol are designed for kink resistance, excellent flexibility, steering and better tip mobility 3. The tip shape with Nitinol is more durable and less likely to prolapse. However, the downside is that it may store torque without necessarily transmitting it tothe tip, therefore wires with single Nitinol core have a tendency to “wind up”
Central core is the basic component of the guidewire. It contributes to the trackability, torqueability and push transmission of the interventional device. The greater is the strength of the material constituting the central core and the greater its thickness, the greater the torqueability and body support provided by it. Stainless steel contributes to more pushability, torqueability and good shape ability, but itis less flexible than newer core materials like Nitinol and also has a tendency to kink. Super-elastic alloy like Nitinol are designed for kink resistance, excellent flexibility, steering and better tip mobility 3. The tip shape with Nitinol is more durable and less likely to prolapse. However, the downside is that it may store torque without necessarily transmitting it tothe tip, therefore wires with single Nitinol core have a tendency to “wind up”
Some guidewires have a composite core design,
employing stainless steel for the longer proximal
part within the wire shaft, and a more elastic alloy
at the tapered distal part within the wire tip, such
as nitinol Runthrough® NS