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Review

Current and emerging catheter technologies for percutaneous transluminal coronary angioplasty

Pages 213-226 | Published online: 10 Sep 2014

Figures & data

Figure 1 Guide catheter design.

Figure 1 Guide catheter design.

Figure 2 Stiffness of guide catheter along its length.

Figure 2 Stiffness of guide catheter along its length.

Figure 3 Shape of a guide showing the curves and body.

Abbreviations: JR, Judkins right; JL, Judkins left; AR, Amplatz right; AL, Amplatz left; 3DRCA, three-dimensional right coronary artery.
Figure 3 Shape of a guide showing the curves and body.

Figure 4 Illustration showing the relative sizes of diagnostic and guide catheters and preferred cases for simple, routine, and complex PCIs.

Note: The relatively thin wall of the guiding catheter when compared with a similar size diagnostic catheter.
Abbreviation: PCI, percutaneous coronary intervention.
Figure 4 Illustration showing the relative sizes of diagnostic and guide catheters and preferred cases for simple, routine, and complex PCIs.

Table 1 Guide catheters for PCI to different coronary arteries

Figure 5 Commonly used guide catheters.

Abbreviations: JL, Judkins left; JCL, Judkins curve left; JR, Judkins right; JCR, Judkins curve right; FL, femoral left; FR, femoral right; AL, amplatzer left; MB, multipurpose.
Figure 5 Commonly used guide catheters.

Figure 6 Backup force calculation of a guide catheter.

Figure 6 Backup force calculation of a guide catheter.

Figure 7 Power position of catheter when performing left percutaneous coronary intervention with a Judkins left catheter.

Notes: (A) Standard position of guide. (B) Power position after active guide catheter manipulation.
Figure 7 Power position of catheter when performing left percutaneous coronary intervention with a Judkins left catheter.

Figure 8 Power position of Hockey stick catheter while performing a difficult right coronary artery angioplasty (distal total occlusion) and straightening of the right coronary artery with deep inspiration.

Notes: (A) Standard position of Hockey stick guide. (B) Power position after guide catheter manipulation.
Figure 8 Power position of Hockey stick catheter while performing a difficult right coronary artery angioplasty (distal total occlusion) and straightening of the right coronary artery with deep inspiration.

Figure 9 Extra backup support by using “mother-child” catheters concept.

Note: (A) Mechanism of enhanced support using a “child” catheter. (B) Use of the “mother-child” technique to increase guide support for balloon or stent delivery; (a) 5-Fr mother guiding catheter with 4-Fr child from Kiwami; (b) standard 5-Fr mother-child catheter.
Abbreviation: JR, Judkins right.
Figure 9 Extra backup support by using “mother-child” catheters concept.

Figure 10 Deep seating of a Judkins right guide catheter to deliver a stent into the distal right coronary artery.

Notes: (A) Initial position of guide catheter in proximal RCA. (B) Deeper intubation of JR guide into mid RCA.
Figure 10 Deep seating of a Judkins right guide catheter to deliver a stent into the distal right coronary artery.

Figure 11 XB catheter for left anterior descending artery changed to an Amplatz left 2 catheter for proper support of percutaneous coronary intervention to the obtuse marginal artery.

Notes: (A) Normal XB 3.5 guide catheter for the left anterior descending not giving enough support to cross a lesion in the obtuse marginal. (B) Changed to Amplatz 2 guide catheter with buddy wire support. (C) Stent not crossing in spite of deep engagement of guide catheter and deep inspiration. (D) & (E) Stent crossed over Iron Man wire guide wire support, after multiple predilatations and attaining more horizontal position of Amplatz guide catheter. (F) Final result with TIMI III flow.
Abbreviation: TIMI, thrombolysis in myocardial infarction.
Figure 11 XB catheter for left anterior descending artery changed to an Amplatz left 2 catheter for proper support of percutaneous coronary intervention to the obtuse marginal artery.

Figure 12 Poor support provided by a Judkins right changed to an Amplatz I with buddy wire support percutaneous coronary intervention to a total occlusion of the mid right coronary artery.

Notes: (A) Poor support provided by a Judkins right guide catheter. (B) Better support provided by the Armplatz left guide and using buddy wire.
Figure 12 Poor support provided by a Judkins right changed to an Amplatz I with buddy wire support percutaneous coronary intervention to a total occlusion of the mid right coronary artery.

Figure 13 Inadequate support provided by a Judkins left guide catheter for an IVUS catheter post stenting of a left main artery.

Notes: (A) Ostium of protected left main showing 80% stenosis. (B) Predilated with a 3.5*8 mm noncompliant balloon. (C) IVUS catheter crossing the lesion. (D) Stenting of protected left main post coronary artery bypass grafting. (E) Initially IVUS catheter crossed the predilated ostial proximal left main lesion but the post stent IVUS catheter could not cross the stent due to inadequate support provided by the Judkins left 3.5 guiding catheter.
Abbreviation: IVUS, intravascular ultrasound.
Figure 13 Inadequate support provided by a Judkins left guide catheter for an IVUS catheter post stenting of a left main artery.

Figure 14 Comparison between the Ikari catheter and the Judkins left catheter.

Notes: (A) Judkins left guide catheter. (B) Ikari left catheter with brachiocephalic angle.
Figure 14 Comparison between the Ikari catheter and the Judkins left catheter.

Figure 15 Optimum catheter selection by matching aortic sinus measurements with guide catheters available on the shelf in the catheterization laboratory.

Notes: (A) Illustration of actual catheter with CCW, CTA & CC2D ; (B) diagrammatic representation CACA, AD and DOAV.
Figure 15 Optimum catheter selection by matching aortic sinus measurements with guide catheters available on the shelf in the catheterization laboratory.

Figure 16 Angioplasty of anomalous right coronary artery with a chronic total occlusion using a modified Amplatz left 1 catheter with balloon support over a Whisper wire.

Notes: (A) Poor support provided by the Amplatz right guiding catheter. (B) Guide changed to on-table modified Armplatz left 1 guide catheter.
Figure 16 Angioplasty of anomalous right coronary artery with a chronic total occlusion using a modified Amplatz left 1 catheter with balloon support over a Whisper wire.