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Toolbox: Catheter Selection

Angiography

Left & Right Coronary Arteries

Commissural Post Front & Away

PCI

Left & Right Coronary Arteries

Commissural Post Front & Away

Angiogram

Self-Expanding Valve

Commissural Post Front

Left System

  • The self-expanding valve has a concave central portion (20-24 mm) which is narrower than native aortic root dimensions.
  • Use smaller catheter: JL3.5 (femoral approach) or a JL3 (radial approach) for left system. Can also use JR4 to engage LCA.
  • If unable to engage, perform non-selective angiogram.
  • Second line: Use guide catheter (Ikari Right 1.0/1.5 or FL3.0).
  • Use guide catheter such as Ikari Right or FL 3.0 with a coronary guidewire to wire coronary artery for more selective engagement.

Right System

  • Use JR4 catheter.
  • If not able to selectively engage, perform non-selective angiogram +/- aortogram.
  • Second line: consider using guide catheter such as Ikari Right 1.5 or Multipurpose (MP).
  • Use coronary guidewire for more selective engagement if needed.
  • Use guide catheter such as Ikari Right or MP with a coronary guidewire to wire coronary artery for more selective engagement.

Commissural Post Away

Left System

  • Use JL3.5 or JR4.
  • Second Line: use catheter like Ikari Right 1.0/1.5.
  • If the skirt is high, catheters such as FR4 or Ikari Right 1.0/1.5 can be used to enter
    from the diamond above the coronary ostia.

Right System

  • Use a standard catheter like JR3.5 or JR4.
  • Use AR2 catheter as the second line, especially if sinuses are wide.
  • If the skirt is high, use MP guide to enter from the diamond above coronary ostia.

Percutaneous coronary intervention (PCI)

Self-Expanding Valve

Commissural Post Front

Left System

  • Use FL 3.0/3.5 guide catheter.
  • Second line guide: Ikari Right 1.0/1.5
  • If difficulty with coronary engagement, rail guide catheter towards the ostium using:
    • Coronary guidewire
    • Balloon support
    • Guide extension catheter

Right System

  • Use FR4 guide
  • Second line guide: Ikari Right 1.5
  • If difficulty with coronary engagement, rail guide catheter towards the ostium using:
    • Coronary guidewire
    • Balloon support
    • Guide extension catheter

Commissural Post Away

Left System

  • Use FL 3.0/3.5 guide catheter.
  • Second line guide: Ikari Right 1.0/1.5
  • If skirt is high, use Ikari Right guide to enter diamond from above ostia and rail guide towards ostium using:
    • Coronary guidewire
    • Balloon support
    • Guide extension catheter

Right System

  • Use FR4 guide catheter.
  • Second line guide: Ikari Right 1.5, AR2 (wide sinuses), MP.
  • If skirt is high, use Ikari Right or MP guide to end Diamond from above coronary ostia and rail the guide towards ostium using:
    • Coronary guidewire
    • Balloon support
    • Guide extension catheter

Angiography

Left & Right Coronary Arteries

Commissural Post Front & Away

PCI

Left & Right Coronary Arteries

Commissural Post Front & Away

Angiogram

Balloon-Expandable Valve

Commissural Post Front

Left System

  • Use standard catheters JL4/JL3.5 to engage coronary arteries.
  • Attempt to engage coronary artery from cell adjacent to commissural post.
  • If unable to engage, perform non-selective angiogram/aortogram.
  • Use standard guide catheter (FL3, VL3, EBU3) with a coronary guidewire to wire coronary artery for more selective engagement.

Right System

  • Use standard catheters like JR4 to engage coronary arteries.
  • Attempt to engage coronary artery from cell adjacent to commissural post.
  • If unable to engage, perform non-selective angiogram/aortogram.
  • Use standard guide catheter (FL3, VL3, EBU3) with a coronary guidewire to wire coronary artery for more selective engagement.

Commissural Post Away

Left System

  • Use standard catheters like JL4/JL3.5 to engage coronary arteries.

Right System

  • Use standard catheters like JR4 to engage coronary arteries.

Percutaneous coronary intervention (PCI)

Balloon-Expandable Valve

Commissural Post Front

Left System

  • Use standard catheters VL 3.5/EBU3.5/FL4 to engage coronary arteries.
  • Attempt to engage coronary artery from cell adjacent to commissural post.
  • If difficulty with coronary engagement, rail the guide towards the coronary ostium using:
    • Coronary guidewire (hydrophilic)
    • Balloon support (2.0 x 12 mm)
    • Guide extension catheter

Right System

  • Use standard catheters JR4/FR4/IM to engage coronary arteries.
  • Attempt to engage coronary artery from cell adjacent to commissural post.
  • If unable to engage, perform non-selective angiogram/aortogram.
  • If difficulty with coronary engagement, rail the guide towards the coronary ostium using:
    • Coronary guidewire (hydrophilic)
    • Balloon support (2.0 x 12 mm)
    • Guide extension catheter

Commissural Post Away

Left System

  • Use standard catheters VL3.5/EBU3.5/FL4 to engage coronary arteries.

Right System

  • Use standard catheters FR4/IM to engage coronary arteries.
Case ExamplesEducational Content

ATHERECTOMY COMPLICATIONS

Case ExamplesEducational Content

BYPASS GRAFT COMPLICATIONS

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

Left Main DK Crush Video ID