Coronary Catheters
A coronary catheter is a special type of catheter that allows for the contrast injection for coronary angiogram as well as the passage of devices required for coronary intervention. Two different types for coronary intervention are available.
Diagnostic Catheter
A diagnostic catheter has a thicker shaft with smaller diameter compared to a guide catheter.
Guide Catheter
- Has thinner wall than diagnostic catheter, hence careful manipulation is required
- Conduit for injecting contrast and transporting guide wires & devices
- Can measure aortic & arterial pressures
- Rotate it while withdrawing or advancing it
Coronary catheters (diagnostic, guide) are manufactured by several different companies and available in various types and shapes. However, the fundamental concept of choosing a catheter hasn’t changed.
Understanding of Guide Catheter Structure
What are primary and secondary curves?
P = Primary curve, S = Secondary curve (Judkins Catheter)
Common Type of Catheters for Native Coronary Artery and Grafts Cannulation
Left Catheters
- Judkins Left
- Amplatz Left
Right Catheters
- Judkins Right
- Amplatz Right
- 3DRC
Universal
- Multipurpose
- Sones
- Castillo
Universal Radial
- Tiger
- Jackey
- Kimney
Graft & IMA Catheters
- RCB
- LCB
- IMA
- IMA VB-1
- (Use JR4 all VGs, Multipurpose right coronary graft, AL1 all VGs to left system)
Catheters Choice for Anomalous Coronary Artery
- AL 0.75/1
- AR 2
- VL/FCL
- 3DRC
Aorta
Normal
Dilated
Narrow
JL Curve
JL4
JL5
JL3.5
VL Curve
VL3.5/VL4
VL4.5/5
VL3
XB
XB 3.5/4
XB 4/4.5
XB 3.0/3.5
AL
AL1
AL2
AL0.75
Q Curve
Q4
Q4.5
Q3.5
Catheters selections should be based on size of aortic root.
Guide Catheter Size Selection for Coronary Intervention
- 6F (2 mm) is the standard
- Allows radial access
- 2 modern monorails balloons fit, 1.75mm Rota burr
- 7F (2.33 mm)
- Bifurcation techniques requiring 2 stents approach : Crush, V stenting
- CTO (2 OTW catheters for parallel wire approach)
- 2.0mm Rota Burr
- 8F (2.66 mm)
- Atherectomy Flexicut
- Rota > 2mm Rota Burr
- IVUS + OTW catheter for guided recanalization
Aorta
Normal
Dilated
Narrow
JL Curve
JL4
JL5
JL3.5
VL Curve
VL3.5/VL4
VL4.5/5
VL3
XB
XB 3.5/4
XB 4/4.5
XB 3.0/3.5
AL
AL1
AL2
AL0.75
Q Curve
Q4
Q4.5
Q3.5
Catheters selections should be based on size of aortic root.
Catheter Selection for Radial Artery Approach
RCA
- Diagnostic angiogram: JR4, TIG, Kimny
- PCI: Ikari Right, AL1, 3DRC
LCA
- Diagnostic angiogram: JL3.5, TIG, Kimny
- PCI: Ikari Left, VL3/3.5, JL, FL
Guide Construction and Support
Tip for Guide Catheter Selection
- Although multiple catheters with various types and shapes are available, some of the guide catheters have a larger internal diameter than its counterpart, such as Medtronic: Launcher (0.071 inches), Cordis: Androit (0.072 inches), Boston Scientific: Convey (0.071 inches), Terumo: Heartrail II (0.071 inches) guide catheter.
There are various types and shapes available in the market. Some of the following are most commonly used during diagnostic coronary catheter.
Various Types and Shapes of Coronary Catheter
Judkins Left
- Judkins Left 3.5
- Judkins Left 4.0
- Judkins Left 5.0
- Judkins Left 6.0
- Judkins Left Short Tip 3.5
- Judkins Left Short Tip 4.0
- Judkins Left Short Tip 5.0
- Judkins Left Short Tip 6.0
Judkins Right
- Judkins Right 3.5
- Judkins Right 4.0
- Judkins Right 5.0
- Judkins Right 6.0
- Judkins Right Short Tip 3.5
- Judkins Right Short Tip 4.0
- Judkins Right Short Tip 5.0
- Judkins Right Short Tip 6.0
- Judkins Right Modified 3.5
- Judkins Right Modified 4.0
- Judkins Right Modified 5.0
- Judkins Right Modified 6.0
Amplatz Catheters
- Amplatz Left 1
- Amplatz Left 2
- Amplatz Left 3
- Amplatz Left 4
- Amplatz Right 1
- Amplatz Right 2
- Amplatz Right 3
- Amplatz Right Modified
- Progressive Right
- Straight Pigtail
- 145º Pigtail
- 155º Pigtail
- Multipurpose A1
- Multipurpose A2
- Multipurpose B1
- Multipurpose B2
- Sones
- Left Coronary Bypass
- Right Coronary Bypass
- Internal Mammary
All images obtained from MeritOEM.
