Long-tip guiding catheter: Successful and safe for left coronary artery angioplasty

A long-tip guiding catheter was designed for angioplasty of the left coronary artery. Principal factors of guiding catheter function were identified, and the catheter's shape was designed to utilize them efficiently. Emphasis was placed on an overbent secondary curve (150–180°) for more precise catheter control. The distal tip of the catheter is 2 cm long in the 4.0 size and the primary bend is shallow, ～20%. A 1.5 cm long segment between the secondary and tertiary curves enhances stability and support. Catheter performance was studied during procedures on 90 patients; 89 patients underwent coronary artery angioplasty and one patient underwent diagnostic angiography. The success rate for angioplasty was 95% with no major complications. Mild pressure damping occurred in 18 patients, and mild catheter displacement from the left main coronary artery occurred in 24 patients. Catheter support was judged as excellent to very good in 82 patients. Judkins or Amplatz catheters were not required during this study. The observed disadvantages of the long-tip catheter were the risk of catheter buckling up during advancement into the left main coronary artery and, perhaps, a higher risk of pressure damping. Superselective engagement of the catheter in the left anterior descending or circumflex arteries may be a problem when the left main coronary artery is very short. This study showed the long-tip catheter to be safe and highly successful for angioplasty of the left coronary artery.     

Double wire technique for additional guiding catheter support in anomalous left circumflex coronary artery angioplasty.

This case report presents an example of the use of the double wire technique for additional guiding catheter bracing support in percutaneous transluminal coronary angioplasty (PTCA) of a stenosis in an anomalous circumflex (CX) artery arising within the ostium of the right coronary artery (RCA). It illustrates the ease of this technique in comparison to conventional guiding catheter cannulation, which may be more difficult and yield poor backup support in this unusual anatomic situation.     

Double wire technique for additional guiding catheter support in anomalous left circumflex coronary artery angioplasty

This case report presents an example of the use of the double wire technique for additional guiding catheter bracing support in percutaneous transluminal coronary angioplasty (PTCA) of a stenosis in an anomalous circumflex (CX) artery arising within the ostium of the right coronary artery (RCA). It illustrates the ease of this technique in comparison to conventional guiding catheter cannulation, which may be more difficult and yield poor backup support in this unusual anatomic situation.     

Improved support for right coronary artery angioplasty with a new guiding catheter.

Inadequate guiding catheter support is a frequent cause for failure in right coronary angioplasty (PTCA). A new guiding catheter designed to provide easy placement in the right coronary and improved stability and backup support is described. Use of this catheter for PTCA of right coronary lesions, the majority of which were considered technically difficult to dilate, in 100 patients resulted in successful dilatations in 88% of patients. Failures were due to inability to seat the guide adequately in 8 patients with narrow aortic roots or unusual coronary origins and to inability to cross a lesion in 4 patients despite good support. In 4 patients successful dilatation was achieved after failure using another presently available guide.     

Double loop guiding catheter: A primary catheter for angioplasty of the right coronary artery

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90- degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75-degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short-tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long-tip catheters were found to be the best choice. Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.     

Improved support for right coronary artery angioplasty with a new guiding catheter

Inadequate guiding catheter support is a frequent cause for failure in right coronary angioplasty (PTCA). A new guiding catheter designed to provide easy placement in the right coronary and improved stability and backup support is described. Use of this catheter for PTCA of right coronary lesions, the majority of which were considered technically difficult to dilate, in 100 patients resulted in successful dilatations in 88% of patients. Failures were due to inability to seat the guide adequately in 8 patients with narrow aortic roots or unusual coronary origins and to inability to cross a lesion in 4 patients despite good support. In 4 patients successful dilatation was achieved after failure using another presently available guide.     

Air embolism in the right coronary artery occurring during the left coronary angioplasty using the guiding catheter with a side hole.

Coronary air embolism is one of the inadvertent complications of coronary angioplasty. We report two rare cases of complicating air embolism in the right coronary artery occurring during control left coronary angiography using a guiding catheter with a side hole, just prior to a coronary intervention procedure for a left coronary artery lesion. The air seemed to be injected into the right coronary artery through the side hole. When we use an angiographic or guiding catheter with a side hole, we should be aware that an air embolism can occur in the contralateral coronary artery and should carefully and repeatedly perform aspiration of the catheter.     

Use of femoral artery guiding catheters via the left brachial artery for transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty using the right brachial artery has been described using either a cutdown and arteriotomy or a percutaneous entry. Each method requires the use of a brachial artery guiding catheter (Stertzer guiding catheter; (USCI). This communication reports the use of percutaneous entry of the left brachial artery and coronary angioplasty performed with femoral guiding catheters. In this manner coronary angioplasty has been successfully performed in 42 of 47 patients (90%) without major complications.     

Late coronary spasm complicating successful angioplasty of the left main coronary artery

A patient with successful percutaneous transluminal coronary angioplasty of the left main coronary artery is described. Two days later coronary angiography was performed because of recurrence of angina pectoris. Spontaneous spasm at the angioplasty site was documented. This potentially lethal complication issues a severe warning against angioplasty of the left main trunk.     

Randomized evaluation of six French Voda-type guiding catheters for left coronary artery balloon angioplasty

In order to evaluate 6 French (6F) Voda-type guiding catheters for left coronary artery balloon angioplasty, we randomized the choice of the guiding catheter in 100 consecutive patients between a Voda (group 1, n = 50) and a Judkins or Amplatz curve (group 2) guiding catheter. Angioplasty success rate (98% for both), need for guiding catheter crossover exchange (2 in group 1 vs. 1 in group 2), fluoroscopy time, and volume of injected contrast were similar in both groups, but the operator's appreciation of good back-up support was better with the Voda-type guiding catheter (90% vs. 74%, P < 0.05). No complications attributed to the guiding catheter were noted in either group. Efficiency of the Voda-type guiding catheter appeared similar for both left anterior descending (n = 35, success rate 100%) and circumflex (n = 18, success rate 94%) coronary artery angioplasty. Voda-type guiding catheters are an efficient and safe approach to routine left coronary angioplasty. They appear to be as effective as a choice bewtween a Judkins or an Amplatz configuration and could be of particular use when a double angioplasty of the left anterior descending and circumflex arteries is attempted during the same procedure. © 1995 Wiley-Liss, Inc.     

Use of a guiding catheter for contralateral femoral artery angioplasty

We describe a unique method employing a transseptal sheath as a “guiding catheter” that allows contralateral retrograde femoral artery access to perform balloon angioplasty of proximal superficial femoral artery lesions. This technique simplifies arterial access, provides support for crossing lesions, and allows angiographic visualization of target lesions during the procedure.     

Use of the internal mammary artery guiding catheter for percutaneous transluminal coronary angioplasty of the shepherd's crook right coronary artery

Percutaneous transluminal coronary angioplasty (PTCA) of shepherd's crook right coronary arteries presents a difficult technical challenge. Presented here are two cases demonstrating the use of an internal mammary guiding catheter for PTCA of shepherd's crook right coronary arteries. The advantages of this guiding catheter, a short tip with an acute distal angle, are emphasized.     

Retrieval of directional coronary atherectomy guiding catheter with angioplasty balloon catheter

Directional coronary atherectomy (DCA) has been shown to be a safe and effective treatment for occlusive coronary artery disease. We report a case of an atherectomy guiding catheter severing in two with successful retrieval of the dislodged segment by an integrated angioplasty balloon catheter system. © 1995 Wiley-Liss, Inc.     

Performance characteristics of a new shape of guiding catheter for PTCA of the left coronary artery.

The inability to successfully perform angioplasty commonly involves inadequate guiding catheter performance. We evaluated the use of a new left coronary guiding catheter for angioplasty (PTCA) of lesions in both the left anterior descending and left circumflex arteries. The Nesto guide in two different sizes was used in 100 consecutive PTCA cases as a primary catheter. The catheter successfully cannulated the left main coronary artery in 93 patients and PTCA was successfully performed in 85 patients for target lesions at various locations in either or both vessels. Positive features of this new guiding catheter include superior back-up support and ease of disengagement.     

Use of angioplasty guiding catheters for improved coronary artery opacification

The following report describes the use of the high flow injection characteristics of a coronary angioplasty guiding catheter to improve coronary opacification in a patient with exceedingly high coronary runoff. This technique offers improved coronary visualization in special cases.     

Performance characteristics of a new shape of guiding catheter for ptca of the left coronary artery

The inability to successfully perform angioplasty commonly involves inadequate guiding catheter performance. We evaluated the use of a new left coronary guiding catheter for angioplasty (PTCA) of lesions in both the left anterior descending and left circumflex arteries. The Nesto? guide in two different sizes was used in 100 consecutive PTCA cases as a primary catheter. The catheter successfully cannulated the left main coronary artery in 93 patients and PTCA was successfully performed in 85 patients for target lesions at various locations in either or both vessels. Positive features of this new guiding catheter include superior back-up support and ease of disengagement.     

Percutaneous transluminal coronary angioplasty with stenting of anomalous right coronary artery originating from left sinus of Valsalva using the Voda guiding catheter: a report of two cases.

Coronary arteries of anomalous origin are uncommon and some forms seem to be predisposed to atherosclerosis. We report two cases of successful stent implantation in an anomalous right coronary artery originating from the left sinus of Valsalva using the Voda guiding catheter.