PCI equipment: guiding catheter selection
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Percutaneous coronary intervention Microchapters |
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Editors-In-Chief: Alexandra Almonacid M.D.; Jeffrey J.Popma M.D.
Overview
Diagnostic catheters used for coronary arteriography are usually constructed from polyethylene or polyurethane with a fine wire braid within the wall to allow advancement and directional control (torquability) and to prevent kinking. The outer diameter size of the catheters ranges from 4 to 8F, but 5 and 6F catheters are used most commonly for diagnostic arteriography.
Guiding Catheter Selection
Judkins Catheters
The left Judkins catheter has been developed to allow entry into the left coronary ostium from the femoral approach with minimal catheter manipulation. A preformed left Judkins catheter can also be used from the left brachial or radial artery, but a catheter with 0.5 cm less curvature than required for the femoral approach is generally better suited for coronary cannulation. The right Judkins catheter is shaped to permit entry into the right coronary artery (RCA) with a small amount of rotational (clockwise) catheter manipulation from any vascular approach.
Selection of Judkins catheter shape is based on the body habitus of the patient and size of the aortic root. The left coronary artery (LCA) is easily engaged with the Judkins left 4.0 catheter from the femoral approach in most patients, whereas patients with a dilated ascending aorta (e.g., in the setting of congenital aortic stenosis and post- stenotic dilation) may require the use of a Judkins left 5.0 or 6.0 catheter.
Patients with large ascending aortic aneurysms may require arteriography with heat-modified catheters to achieve Judkins left 7.0 to 10.0 shapes. Use of a Judkins shape that is too small for the ascending aorta often leads to folding of the catheter within the aortic root. The best technique for removing a folded Judkins left catheter from the body involves withdrawing the folded catheter into the descending aorta and advancing a guidewire anterograde in the contralateral common iliac artery. On withdrawal of the catheter and guidewire together, the catheter straightens and can be removed safely from the body without disrupting the arterial access site.
Amplatz Catheters
Amplatz catheters can be used for the femoral or brachial approach to coronary arteriography. The Amplatz catheters are an excellent alternative in cases in which the Judkins catheter is not appropriately shaped to enter the coronary arteries. The Amplatz L-1 or L-2 catheter may be used for coronary angiography from the right brachial or radial approach. A modified right Amplatz catheter (AR-1 or AR-2) can be used for engagement of a horizontal or upward takeoff RCA or SVG.
Other Catheters
Other catheters used for coronary arteriography include the left IMA catheter with an angulated tip that allows engagement of the IMA or an upward takeoff RCA. Catheter shapes that permit engagement of SVGs include the multipurpose catheter, right Judkins, modified right Amplatz, and hockey stick catheters. Specially designed catheters for engagement of the coronary arteries from the radial artery have also been developed.