Select Page

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