Diagnostic Catheters

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Diagnostic catheters for coronary angiography are classically 4 or 5 Fr catheters. Other than guide catheters they are soft, elastic and provide minimal back-up. Therefore they guarantee a miximum in safety, beeing as a atraumatic as possible. Main puprose of These catheters is measurement of pressure and injection of contrast medium - be it selective or semiselectiv - for visualisation of cardiac vasculature, the heart cavities or the large thoracic vessels. Catheters intended for maneouvers in the aortic root are typically of

For coronary angiography a wide range of catheter designs is commercially available. While composition and physical characteristics (e.g. torque stability, stiffness, etc) of diagnostic coronary catheters are roughly similar in most designs, the specific curve and tip Formation is the essential Feature. Different curve types represent the multitude of coronary anatomical findings. Finding the suitable catheter for optimal Intubation and selective coronary angiography in each Patient is one of the main challenges in diagnostic coronary angiography. Note that most catheter designs are conceptually dedicated for transfemoral use (Judkins, Amplatz, etc). Only a minority of fabrications (e.g. Tiger, Kimny, Tilon) have been developed for the transradial Approach.

Side-holes. Most catheters types are available with sideholes. The common practice varies considerably as some cath labs on principle use guide catheters with sideholes, while others almost condemn them. Without a doubt, in certain coronary pathologies, such as ostial lesions or very tight proximal RCA lesions or also left main disease, side holes increase the procedural safety. They do so by avoiding the "wedge-phenomenon", which describes occlusion of the vessel by the introduced catheter resulting is low flow distally. Accordingly a dampened low-profile pressure tracing is obtained. If the catheter enganged the Stenosis and blocks it, blood is sucked in through the sideholes and can perfuse the otherwise occluded vessel. A downside of sidehole design is the unequal Distribution of contrast medium, as the injectet contrast may "escape" through sideholes. Also note, that flow wire measements have been originally intended for non-sidehole catheters.

French sizes. While diagnostic coronary angiography is usually performed with 5 French catheters, the majority of PCI can be performed with 6 French guide catheters. However, larger bore catheters have some typical Advantages. As the item as such is heavier and more stable, the Support and back-up are better. Because of the same reasons, torque Transmission is superior and becaus of the larger lumen, angiographic visualisation is usually better. Of course, larger catheters Need larger puncture in the Access vessel, inceasing the access-site complication rate. In General, use of contrast is higher and - last but not least - use of 7 or 8 French for transradial approch is associated with higher rates of vessel Trauma.

JUDKINS catheter The Judkins design is the perhaps most widely distributed coronary artery catheter type world wide. Judkins left ("JL" or also referred to als "FL" for femoral left) and Judkins right ("JR") are especially reknowned for easy handling and safety. Beeing the Standard catheter set for Diagnostik coronary angiography in many catheter laboratories, the vast majority of patients can be examined with use of Judkins catheters in the appropriate size. Judkins catheters have very high success rate for Intubation of the coronary ostia and engage with low back-up, making them a good first choice for beginners. On the other Hand, back-up is moderate to low, which can be a relevant disadvantage in PCI. In the traditional Judkins types, sizing of the tip curve is done by number. Most commonly used sizes are 4 (e.g. "classic set" with JL4 and JR4), followed by 3.5 or 4.5. Lower numbers represent smaller curvatures, thus Fitting smaller anatomies (e.g. JL3.5 for an elderly Lady with BMI 18). Accordingly higher numbers indicate a larger secondary curve (e.g. JL5 for a male with dilated aortic root). Some interventionalists prefer a mild undersizing for the transradial Approach, as smaller catheters may torque more smoothly in the aortic root. A JR catheter can be used for Intubation of Bypass grafts originating from the ascending Aorta, and may even be suitable for Imaging of LIMA or RIMA grafts.

AMPLATZ catheter The Amplatz catheter Family is composed of Amplatz left in sizes I and II ("AL1 and AL2") and Amplatz right I and II ("AR1/2 or ARmod" [for modified]). Amplatz catheters are widely used and inherit some special features which make them valuable tools in many settings. For example, the AL1 catheter can be used for intubation of many non-Standard variants of RCA ostia. Other than many catheters used for intubation of the RCA, the AL1 and AL2 provide excellent back-up, which is of high relevance for challenging RCA-PCIs. However, on the other hand, especially AL-type catheters can exert push- and sheer-forces on the RCA ostia or proximal RCA segments. In contrast to the Judkins right, this makes the AL catheters more aggressive and more traumatic. The Amplatz right is a commonly used catheter for intubation of saphenous vein bypass grafts (SVG), especially as guiding catheters for SVG interventions. AL1 is well suited for steep take-off of target vasculature, making it valuable in shepard's crook RCA anatomy or certain saphenous vein graft situations.

HOCKEY STICK catheter The hockey stick catheter is used for RCA or saphenous vein grafts only. Because of its curve, the catheters provides good Support in shepard's crook RCA anatomy, while possibly "leaning" on the aortic cusp leading to rather deep intubation. Hockey stick catheters are available in sizres I, II and III.

3DRC catheter Also referred to as the Williams technique, this catheter is a popular choice, suitable for many RCA anatomies. Its three dimensional curve has limited back-up is of good use for the Treatment of ostial lesions. Because of its short curve, also Intubation of internal mammary artery (left or roght) can be performed with this catheter type.

Internal mammary artery catheter (IMA) Because of its short tip with an acute distal angle, this catheter is designed for Intubation of left and right internal mammary artery.

MULTI PURPOSE catheter The multipurpose catheter has a longer smooth curve than the JR4. It comes in sizes I and II. Multipurpose catheters as the name implies, can be used for multiple types of applications. They may be used to for right heart catheterization, crossing an ASD or PFO or for angiography or endomyocardial biopsy. While they are rarely used for right and left coronary angiography, intubation of a SVG, especially as Guide for bypass intervention, is a common practice. In this Setting the MB guide (other than the JR e.g.) exerts excellent back-up.

Others:

Right Coronary Back-up catheter (ECR)

Kimny catheter and Tilon catheter

SONES catheter The Sones catheters Comes in differents sizes (I, II, III) and can be used for both cornary artery ostia. With a very specific technique, a Loop must be formed upon the aortic cusps, and engangement of the ostia is achieved via pull back. The Sones technique is nowadays almost abandonned because of its complicated nature.