Toolbox: Catheter Selection
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
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.
