*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*


Provide support for intervention and stability with multiple exchanges of

Guide catheters although have three layers (diagnostic have two layers); they have thinner walls than diagnostic catheters to allow larger lumen. This makes them prone to kinking and weakening, and the middle layer is usually braided wire to minimize this risk. The tip of guide catheter is not tapered (diagnostic

Moving/rotating the guide catheter similar to diagnostic catheters with slower speed and patience to transmit torque (1 to 1 torque transmission) when

Advancing guide catheter slowly to avoid deep coronary intubation and

Live monitoring of pressure wave to notice any change (ventricularization,

Guide catheters are used with hemostasis valve to allow instrumentation and

A lot of operators and some companies recommend keeping the 0.035″ guide wire inside while trying to engage the target coronary and adjust the location of the wire based on the operator assessment of the guide segment that need more support to stay straight. This only possible with a hemostasis valve (Tuohy) in place. Operator should make sure to de-air the system well while using this technique and assure good seal that prevents air from entering the system. Most operators keep the main 0.035″ guide wire in till they wire the

balloons, stent, guide extensions, and adjunct therapies.

*2.3.1 Basic information to help operator handling guide catheters*

Allow coronary flow during intervention.

catheters have tapered tip).

*Coronary Artery Intervention Techniques DOI: http://dx.doi.org/10.5772/intechopen.93458*

withdrawing or advancing.

damping or disappearance).

imaging at the same time.

damage.

**213**

**Figure 2.**

*Medina classification.*

**Table 7.**

*Factors affecting lesion scoring in the syntax score.*

of any hemodynamic support device in cardiogenic shock in the setting of acute coronary syndrome.

## **2.3 Choosing the appropriate guide catheter**

Several medical companies provide wide range of options for guide catheters designs. Each has their own catheters designs for radial or femoral approach. They share the general principle and look similar. Operator should be knowledgeable of advantages and disadvantages of each and be comfortable to deal with challenges and complications as they appear.

Choosing the appropriate guide catheter is a very important step. It can make the intervention significantly easier and smother than using inappropriate guide catheter.

Goals of guide catheter:

Engage target coronary coaxially to avoid damage of the engagement and deep intubation.

*Coronary Artery Intervention Techniques DOI: http://dx.doi.org/10.5772/intechopen.93458*

**Figure 2.** *Medina classification.*

> Provide support for intervention and stability with multiple exchanges of balloons, stent, guide extensions, and adjunct therapies. Allow coronary flow during intervention.

#### *2.3.1 Basic information to help operator handling guide catheters*


of any hemodynamic support device in cardiogenic shock in the setting of acute

Diffuse disease/small vessels +1 per segment number

**Lesion characteristics Impact on syntax score**

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

First segment visible beyond total occlusion +1 per nonvisible segment

Total occlusion X5 Significant lesion (50–99%) X2

Age > 3 months +1 Blunt stump +1 Bridging +1

Side branch present +1

1 diseased segment +3 2 diseased segments +4 3 diseased segments +5 4 diseased segments +6

Type A, B, C +1 Type D, E, F, G +2 Angulated <70° +1 Aorto-ostial lesions +1 Severe tortuosity +2 Length > 2 cm +1 Heavy calcifications +2 Thrombus +1

Several medical companies provide wide range of options for guide catheters designs. Each has their own catheters designs for radial or femoral approach. They share the general principle and look similar. Operator should be knowledgeable of advantages and disadvantages of each and be comfortable to deal with challenges

Choosing the appropriate guide catheter is a very important step. It can make the intervention significantly easier and smother than using inappropriate guide

Engage target coronary coaxially to avoid damage of the engagement and deep

coronary syndrome.

**Table 7.**

Diameter reduction

Total occlusion

Trifurcations

Bifurcations

catheter.

**212**

**2.3 Choosing the appropriate guide catheter**

*Factors affecting lesion scoring in the syntax score.*

and complications as they appear.

Goals of guide catheter:

intubation.

coronary with 0.014 guide wire and secure guide engagement. This technique is mostly used for radial approach especially in patients with extensive tortuous vessels.

6Fr guide catheters:

*Coronary Artery Intervention Techniques DOI: http://dx.doi.org/10.5772/intechopen.93458*

size related to stent size.

7Fr guide catheters:

8Fr guide catheter:

*factors*

Anatomical factors:

**215**

Limited in availability.

size.

The workhorse size for most of PCI cases.

in preparation to deal with complications: Allow for simultaneous double stenting techniques. Allow for rotational atherectomy max size Rotablator 1.75.

Allows for two over the wire balloons.

Used for high risk interventions and CTO.

Allow for rotational atherectomy max size Rotablator 2.0.

directed true lumen reentry and balloon are required.

Does not allow simultaneous double stenting techniques.

Allow for rotational atherectomy max size Rotablator 1.5.

Allow for performing kissing rapid exchange balloons of almost any coronary

Allow for simultaneous balloon and stent deployments but with limitation of

Limited on the size of covered stent that can be used. For Graftmaster covered stent (Max size 3.5 mm stent). Newer PK papyrus covered stent can fit in 5Fr

The most commonly used size in high risk interventions for technical support or

Required for complex CTO intervention where intravascular ultrasound (IVUS)

*2.3.3 Choice for guide catheter tip curve, shape and length for PCI depends on several*

The access approach: radial right, left or femoral. Technically, most of femoral guide catheters could be used in radial approach and vice versa. However, some guide catheters are originally designed for radial approach (i.e. XB) and would be more effective if it is used for the same purpose especially nonexperience operators and in challenging interventions. A big advantage of radial approach is the availability of multiple guide catheter that can be used as a single catheter to perform diagnostic and intervention using same catheter for left and right with very good support and without the need to exchange. Some of these guide catheters are: EBU, Kimny, Q-Curve, Multi-Aortic Curve MAC and even Amplatz left. Manipulating and adjusting the guide bend with 0.035″ wire might be required to achieve that (Wire assisted guide engagement technique). Using the guide wire can make any left contralateral support catheter (EBU, XB, Kimny, Voda, Q-Curve, FCL, MAC, CLS, Kiesz left, Amplatz left) a single catheter for both left and right but this requires caution and experience to avoid advancing the 0.035″ wire inside the coronary (**Figure 3**). Left radial approach is similar to femoral approach in regard to guide catheter choice.

The diagnostic catheter used to perform diagnostic angiogram is one of the most important factors. The diagnostic angiogram procedure is very important in general in deciding the choice for interventional guide catheter as it provides information about the difficulty of vessel engagement, vessel take off, position of the heart in the chest, ascending aortic length, width and orientation in chest, length and degree

for sizes up t0 4.0 mm and requires 6Fr guide for >4.0 mm stents.

