Use of Sheath (Probing CatheterTM) to Enhance Efficacy of the ProbeTM Dilatation Catheter

Coronary angioplasty of very distal or subtotal lesions has been markedly improved with the recent development of the Probe^TM dilatation catheter. However, despite its very low profile, the Probe^TM has certain limitations. We describe a new device. the Probing Catheter^TM, that, in conjunction with the Probe^TM increases the success rate and facilitates coronary angioplasty of very distal or high grade lesions.     

Clinical experience with low profile fixed wire balloon catheter system for percutaneous transluminal coronary angioplasty

Clinical records of the first 45 consecutive patients (66 lesions) in whom the Probe TM a balloon on the wire, was used for percutaneous transluminal coronary angioplasty have been reviewed. The aim of this analysis was to establish the efficacy and safety of this device. Majority of the lesions taken up were considered severe and difficult to cross. The probe was the 1st catheter used in 51 lesions (77%) and in 15 lesions (23%) it was used after other balloon catheters. In 88% (58/66) of lesions treated the Probe reduced the stenosis to less than 50% of the luminal diameter. Of the 45 patients treated 39 (87%) had a successful result. Of the 19 patients with multiple lesions 74% (14/19) had complete revascularisation and in 16% (3/29) had the most significant vessel dilated. Two patients (3%) required urgent coronary artery bypass surgery for acute occlusions. There was no hospital death. Of 50 probe devices used 5 (10%) malfunctioned: the balloon ruptured (at 5 Bars pressure) in 2 instances, balloon twisted causing "Volvulous" in 1 and balloon failed to deflate in 2 cases. The probe has significant advantages over other balloon systems for treating severe coronary lesions because of its low profile. It is however a delicate catheter system and prone to malfunction if not handled with care. Our results show that it is an excellent system for opening difficult and tight coronary lesions.     

Balloon assessment of patent foramen ovale morphology and the modification of tunnels using a balloon detunnelisation technique

Background: Percutaneous coronary intervention (PCI) using a guiding catheter with small diameters may have a favorable impact on vascular access complications and patient morbidity. Here, we report the initial results of PCI using a 4‐Fr coronary accessor. Methods: A total of 31 patients underwent 4‐Fr PCI. Exclusion criteria for 4‐Fr PCI were (1) lesions associated with large side branches requiring wire protection or kissing balloon technique and (2) planned use of angioplasty devices which were not compatible with 4‐Fr catheter. Results: A total of 36 lesions, including 4 chronic total occlusions (CTO), were treated. Access sites included radial artery in 19 patients (61%), brachial artery in 8 (26%), and femoral artery in 4 (13%). Four‐Fr PCI was successful in 34 of 36 lesions (94%) in 29 of 31 patients (94%). One of the two unsuccessful patients was a case of CTO, and the other a case of tortuous right coronary artery. In both, crossover to a 6‐Fr PCI was necessary. Among successfully treated 34 lesions of the 29 patients, coronary stents were deployed in 30 lesions (88%). There were no stent dislodgements or inadequate contrast opacification. No access‐site related complications including radial artery occlusion were observed. Conclusions: PCI with a 4‐Fr coronary accessor is a viable alternative to the use of larger guide catheters. The advent of 4‐Fr stent delivery system may afford a less invasive approach for the treatment of patients with coronary artery disease. © 2008 Wiley‐Liss, Inc.     

Efficacy of a new angioplasty catheter for severely narrowed coronary lesions

Conventional over the wire dilation catheters may be unsuccessful in crossing coronary lesions that are severely narrowed. Hence, a new, extremely low profile coronary angioplasty catheter specifically designed to dilate such lesions was investigated. The catheter features a 2.0, 2.5 or 3.0 mm (inflated diameter) balloon mounted on a guide wire. The deflated profile of the 2.0 mm balloon measures 0.020 +/- 0.001 in. (0.51 +/- 0.03 mm). The catheter can be used in conjunction with 7F angiographic or 8F guide catheters. The catheter was used in 61 patients, aged 43 to 86 years, with predominantly Canadian Cardiovascular Society class III-IV angina. Dilation was attempted in 77 lesions. Lesion length averaged 5.7 +/- 3.1 mm (mean +/- 1 SD), minimal diameter 0.51 +/- 0.25 mm and internal vessel diameter 2.27 +/- 0.43 mm. Sixty lesions (78%) were successfully dilated to less than 50% residual stenosis with this catheter alone; nine lesions were further dilated with a larger balloon catheter. The new catheter was unable to cross 13 lesions (17%); only 2 of these lesions were subsequently crossed with a conventional over the wire system. On the other hand, the catheter was used after failure of conventional dilating catheters in 21 lesions and was successful in 16. The new catheter was particularly valuable for distal lesions and those demonstrating 90 to 99% diameter reduction. For all lesions crossed, stenosis decreased from 76 +/- 11 to 29 +/- 12% after 2.9 +/- 2.7 inflations and peak inflation pressure of 8.0 +/- 2.9 bar. Complications were rare; coronary occlusion occurred in two lesions (3%) and dissection in three lesions (4%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnum Meier wires with Crag Fx wire catheter for total occlusive coronary arteries

Magnum Meier wire was used with Crag Fx wire catheter instead of Magnum balloon catheter to facilitate wire crossing through total occlusion by improving flexibility of the system without losing wire pushability. Of 372 coronary angioplasty procedures performed between January 1994 and April 1995, there were 12 subacute occlusions with an interval of 3 wk or less and 30 chronic occlusions with an interval of >3 wk. Regular over-the-wire-type balloon catheters failed to dilate four subacute occlusions and nine chronic total occlusions. Magnum Meier wire with Crag Fx wire catheter was tried for one subacute occlusion and four chronic occlusions that were undilatable with a regular balloon system and successfully dilated the subacute occlusion and three of the chronic occlusions. The lesions successfully dilated by this new approach were either long or tandem lesions in vessels that were excessively tortuous or showed an acute angle at the orifice. Thus the Magnum Meier wire with Crag Fx wire catheter can be a useful tool for dilating totally occluded lesions in tortuous coronary arteries. Cathet. Cardiovasc. Diagn. 40:198–201, 1997. © 1997 Wiley-Liss, Inc.     

Initial experience with the Europass™: A new ultra-low profile monorail balloon catheter

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass? coronary angioplasty catheter is a monorail Duralyn? balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass? balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure. © Wiley-Liss, Inc.     

Judkins Left指引导管在起源异常的右冠状动脉经桡动脉行经皮冠状动脉介入治疗中的应用

目的评价Judkins Left系列指引导管在起源于左冠状窦的右冠状动脉经桡动脉行经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性。方法 11例患者起源于左冠状窦的右冠状动脉存在狭窄或闭塞病变,均采用右侧桡动脉穿刺,选择JL 3.5或JL 4.0指引导管行右冠状动脉PCI,根据病变情况必要时应用双导丝技术或5进6子母导管技术增加指引导管同轴性和支撑力。慢性闭塞病变常规应用微导管增加指引导丝支撑力,以便于更换导丝。观察手术成功率、并发症和近期随访结果。结果 11例患者中,3例为右冠状动脉慢性闭塞病变,8例为严重狭窄病变,同时合并左冠状动脉病变。所有患者均使用Judkins Left系列指引导管经桡动脉成功完成右冠状动脉PCI,7例应用JL 3.5指引导管,4例应用JL 4.0指引导管。2例在Judkins Left系列指引导管基础上应用5进6子母导管,其中包括1例右冠状动脉慢性闭塞病变;4例应用双导丝技术增加支撑力。3例慢性闭塞病变在微导管支持下均成功行PCI,其中1例先应用双导丝技术、后5进6子母导管增强支撑力。所有患者均成功置入药物洗脱支架,共置入支架19枚,每例右冠状动脉置入支架1~3（1.7±0.7）枚,置入支架长度为18~99（44.1±23.8）mm。术中所有患者均未出现冠状动脉穿孔、栓塞或夹层等并发症,手术成功率100%。住院期间无心脏压塞及支架血栓等并发症。术后临床随访6~12个月,无死亡及心肌梗死等不良心血管事件发生。结论对于右冠状动脉起源于左冠状窦病变,经右侧桡动脉途径,可以选择Judkins Left系列指引导管行PCI,支撑力不够时,可辅以其他增加支撑力的技术,如微导管技术、双导丝技术、子母导管技术等完成手术操作。     

Probe angioplasty of total coronary occlusion using the Probing Catheter technique

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra-low-profile Probe "balloon on a wire" device. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with "absolute" coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P less than .01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no serious complications including no vessel perforations with this technique. The Probing Catheter technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.     

Percutaneous Transluminal Coronary Angioplasty Through 5 French Diagnostic Catheters

In 130 patients, coronary angioplasty (PTCA) with fixed wire balloons through 5 French (F) diagnostic catheters was performed immediately following diagnostic coronary angiography. Patients with complex lesions or in whom the need for alternative devices was likely such as stents were excluded. A total of 151 lesions were attempted. Primary success with 5F systems was achieved in 92% of lesions. In 7 cases, the 5F system failed to cross the stenosis and a change to a larger guiding catheter was necessary. Of these 7 cases, 6 could be dilated successfully with 6 or 7F systems. In one patient in whom the fixed wire balloon was not able to cross a subtotal stenosis of an obtuse marginal branch through the 5F catheter, a Monorail system through a 6F guiding catheter failed as well. The overall technical success rate was 96%. Cardiac complications occurred in 2% of patients (3 patients with Q-wave myocardial infarction). Two other patients (1.5%) with suboptimal PTCA results underwent bypass surgery. PTCA through small diagnostic catheters is a valid alternative technique in selected patients. It is safe and leads to high success rates. Advantages of this technique include 1) less peripheral and coronary trauma; 2) enhanced patient comfort; 3) economical advantages.     

A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions.

Transradial coronary interventions (TCI) are occasionally limited by radial spasms and postprocedural radial occlusions, which are related to the radial diameter and which possibly may be reduced by the use of smaller guiding catheter. However, 5 Fr, 0.058" lumen diameter guiding catheter affords less strength, visibility, and backup. In a randomized study, we investigated procedural and clinical success and vascular access complications of 5 Fr in comparison to 6 Fr guiding catheter. One hundred seventy-one patients with coronary lesions suitable for at least 5 Fr transradial approach (i.e., normal Allen test, only balloon angioplasty and stent) were randomly assigned for 5 or 6 Fr TCI. The primary combined endpoint was procedural and clinical success, and secondary endpoints were vascular access complications and the occurrence of postprocedural radial occlusions at 1-month follow-up. Procedural success was achieved in 95.4% of 5 Fr and 92.9% of 6 Fr patients. Selective cannulation of the coronary ostium failed in 1.1% of 5 Fr and 4.8% of 6 Fr patients (P = 0.08). Minor hematomas without need for surgical repair or blood transfusions occurred in 1.1% (5 Fr) and 4.8% (6 Fr; P = 0.07); 1.1% of 5 Fr and 5.9% of 6 Fr patients (P = 0.05) suffered loss of radial pulse due to radial occlusion. Selected noncomplex coronary lesions can successfully and safely be treated either with 5 or 6 Fr guiding catheters. A tendency of higher procedural success rates and lower vascular access complications was documented after 5 Fr in comparison to 6 Fr TCI. This was particularly the case among patients with small radial diameters.     

Preliminary experience with 5 and 6 French diagnostic catheters as guiding catheters for coronary angioplasty

With the reduction in profile of balloon dilation catheters, until recently, it has been the internal dimensions and performance of the guiding catheter that has mandated the use of 7, 8 or 9 French (F) systems for the performance of percutaneous transluminal coronary angioplasty (PTCA). A new 5F catheter design (Sherwood Medical Co., St. Louis, MO) provided a large inner lumen (0.4") permitting use of 0.20-0.22" fixed-wire PTCA balloon catheters with good coronary visualization. Potential advantages include reduced coronary artery ostial trauma and catheter induced damping and enhanced patient comfort. We report our initial experience in 14 patients undergoing PTCA with a 5 and 6F guide/fixed-wire system. Mean age was 63 +/- 10 (43-78 years). PTCA indications: Cardiogenic shock (1), post-myocardial infarction angina pectoris (2), grade III angina (5) and unstable angina pectoris (6). Vessel attempted: Left anterior descending (3), circumflex (4), obtuse marginal (2), diagonal (1), right coronary artery (3), and internal thoracic artery (1). Twelve patients had femoral approach; two brachial approach. The USCI Probe (USCI Division, Billerica, MA) was used in 8 lesions and SCIMED ACE (SCIMED Life Systems, Maplegrove, MN) catheter in 7 lesions. Successful 5 or 6F guide/fixed-wire dilations reduced the stenosis (77 +/- 14 to 37 +/- 30%) and were successfully performed in 79% (11/14). One 5F patient required 8F guiding catheter and was dilated with 2.0 fixed-wire balloon. A second failed 5F PTCA could not be dilated with any larger conventional system. A third total occlusion could not be crossed with a guidewire or fixed wire balloon. No patient had a complication.(ABSTRACT TRUNCATED AT 250 WORDS)     

应用子母导管介入治疗复杂冠状动脉病变

目的:复杂冠状动脉病变（慢性闭塞性病变、严重迂曲病变、弥漫钙化）的介入治疗往往需要指引导管提供较强支撑力,单纯指引导管自身能提供的支撑力常常不够。本研究旨在初步探索子母导管系统在复杂冠状动脉病变介入治疗中需要强支撑力时应用的有效性与安全性。方法: 选择泰尔茂公司的Heartrail子母导管系统,系由一根5F的子指引导管和一根6F或7F的母指引导管构成。5F Heartrail子指引导管为直头指引导管,其内径为0059 in（1 in=254 mm）,长度为120 cm,比母指引导管长20 cm。使用方法是,母指引导管到位后,送入经皮腔内冠状动脉成形术（PTCA）导丝至冠状动脉内,沿PTCA导丝送入子导管至母导管远段,但不伸出远端,送入PTCA球囊至冠状动脉内,沿球囊导管推送子母导管进入冠状动脉内,根据需要提供的支撑力决定子母导管伸出指引导管的长度。结果: 自2008年6月~2010年12月共选择常规方法导丝、球囊或支架不能通过的复杂冠脉病变共26例（左前降支5例,左回旋支6例,右冠状动脉15例）,其中慢性闭塞性病变6例（23%）,血管迂曲15例（58%）,近段血管有支架植入10例（38%）,钙化病变15例（58%）,其中24例成功完成支架植入,成功率为92%,2例失败,均为球囊不能通过病变处,术中发生空气栓塞2例（8%）,经冠脉注射动脉血后血流通畅,术中无血管夹层及冠脉穿孔等并发症。随访6个月无死亡、再发心梗等心脏事件。结论: 子母导管系统应用于常规方法不能成功的冠脉复杂病变可增加支撑力,有助于远端支架植入,应用有效且安全,但术中需注意空气栓塞的发生。     

Angioplasty of chronic total coronary occlusions with the use of six French guiding catheters

The efficacy of 6 French guiding catheters for angioplasty of chronic total coronary occlusions was evaluated in 61 consecutive patients. The duration of the occlusion was determined angiographically, or estimated from an index clinical event. Endpoints were procedural success, defined as recanalization with less than 50% residual stenosis without major complications; and the need to change to larger-sized guiding catheters. Recanalization was attempted in 62 chronic total occlusions; 35 were located in the left anterior descending coronary artery, 18 in the right coronary artery, and 9 in the left circumflex coronary artery. The mean duration of the occlusion was 6.0 ± 6.6 months; the range was 2–39 months. Lesion morphology included abrupt or diffuse occlusion (55%), a side branch originating at the occlusion (47%), and bridging collaterals (23%). Death, urgent coronary bypass surgery, or myocardial infarction did not occur. Recanalization was successful in 51 of the 62 total occlusions (82%); 49 were completed successfully with a 6 French guiding catheter, and 2 were successful after changing to a larger-sized guiding catheter (which was required for peripheral vessel tortuosity in one patient, and to obtain better back-up support in another). Three other attempts remained unsuccessful after a changing. A total of 12 Palmaz-Schatz stents were implanted in 11 patients for an unsatisfactory result or type C dissection, using the same 6 French guiding catheters. These preliminary findings indicate that 6 French guiding catheters are both effective and safe for angioplasty of chronic total occlusions. Cathet. Cardiovasc. Diagn. 40:255–260, 1997. © 1997 Wiley-Liss, Inc.     

应用5F引导导管经桡动脉行冠状动脉介入治疗

目的 评价应用5F引导导管经桡动脉行冠状动脉(冠脉)介入治疗(PCI)的可行性、安全性及优越性，探讨其应用策略。方法 应用5F引导导管经桡动脉对120例患者的166处病变进行PCI，桡动脉穿刺成功后动脉鞘内注入维拉帕米5mg，根据造影显示冠脉起始段和病变近端的情况选择合适引导导管，按常规进行PCI操作；术后立刻拔出鞘管，加压包扎穿刺处，4h后解除加压包扎；术后仅限制患者穿刺侧上肢活动。结果 右冠脉(RC)病变43例中有67．4％应用Judkins RC导管(JR)，32．6％应用Amplatz导管。92例患者的121处左冠脉(LC)病变，66．3％应用Judkins LC导管，18．5％应用EBU导管，15．2％应用Amplatz LC导管。2例静脉旁路病变均应用JR。PCI成功率97％；5处(3％)仅行经皮冠脉成形术未成功；并发症仅有1例(0．8％)桡动脉闭塞，但不影响手部供血。结论 应用5F引导导管经桡动脉行PCI具有可行性，由于导管细软，大大降低冠脉和穿刺部位的并发症，具有很高的安全性和优越性；但操作难度较大，需掌握导管的选用策略，以增加导管的支持力和同轴性，提高成功率。     

Reopening of Chronic Coronary Artery Occlusions by Low Speed Rotational Angioplasty

Following successful application in chronic peripheral artery occlusions, rotational angioplasty was refined and miniaturized for application in patients with chronic coronary artery occlusions. The new catheter system comprises a motor-driven rotating inner steel catheter made up of several steel coils providing maximum elasticity and complete torque control with an olive-like rounded tip (1.0–1.7 mm). The catheter has a lumen for contrast injection and a shielding plastic tube. It is introduced through a conventional 8 Fr guiding catheter. The slowly rotating (200 RPM) catheter passes nontraumatically through the occlusions, thus creating a new channel with smooth contours in a "remodeling" fashion. Once the channel (diameter 1–1.5 mm) is confirmed angiographically, balloon angioplasty is performed over an exchange wire in conventional technique. The new technique was applied to patients with chronic coronary occlusions. Reopening was first attempted with conventional guidewire technique. If the occlusion could be probed with the guidewire, patients were excluded from the study. Twenty patients in whom the occlusion could not be probed with a wire were studied: 1 ACVB, 2 LAD, and 17 RCA. Average duration of occlusion was 7.4 months; it exceeded 3 months in 15/20 and 6 months in 12/20 patients. Successful reopening was achieved in 9/20 (3 from the first 10, 6 from the second 10 patients). No vessel wall perforation or any other severe complication was encountered. Residual stenosis diameter ranged from 30%–70%. Duration of occlusion was similar among patients from the successful and unsuccessful group. It is concluded that with low speed rotational angioplasty reopening of chronic coronary artery occlusions can be achieved in a considerable part of patients in whom conventional technique is unsuccessful. (J Interven Cardiol 1989:2:3)     

Probe™ angioplasty of total coronary occlusion using the probing catheter™ technique

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra-low-profile Probe? “balloon on a wire” device. An intracoronary Probing Catheter? was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe? Into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with “absolute” coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P<.01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no Serious complications including no vessel perforations with this technique. The Probing Catheter? technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.     

Lesion protection during fixed-wire balloon angioplasty: Use of the “buddy wire” technique and access catheters

Fixed-wire (FW) coronary angioplasty procedures have gained widespread acceptance in some institutions as a primary choice for all angioplasty procedures. These single-lumen, low-profile devices provide distinct advantages as compared to over-the-wire systems in certain circumstances. However, they have not allowed for lesion protection or guidewire access if the situation arises. Two techniques are available to provide lesion protection during FW coronary angioplasty. They are the buddy wire technique and the use of subselective intracoronary access catheters. Access catheters can be used as primary, pre-loaded devices or as secondary devices to be used over an extended FW balloon catheter. These techniques can widen the applications of FW balloon angioplasty.     

Clinical outcomes following predilation with a novel 1.25‐mm diameter angioplasty catheter

Objective: An unmet need is represented in angioplasty catheters that permit the predilation stage of treating complex coronary anatomy oftentimes not amenable to conventional device therapies. Background: Lesion preparation with balloon angioplasty prior to stent placement remains the most common method of percutaneous coronary revascularization. Methods: Clinical and angiographic outcomes were evaluated following a treatment strategy of coronary artery disease that included predilation with a low‐profile, 1.25‐mm angioplasty catheter prior to stent placement. The study primary end point of procedural success was defined as successful device delivery and lesion treatment, including the absence of clinically significant perforation, arrhythmia, flow‐limiting dissection, or reduction in baseline Thrombolysis In Myocardial Infarction (TIMI) grade with final achievement of TIMI 3 flow. Results: Among 51 patients (54 lesions), predilation using a 1.25 mm angioplasty catheter was associated with procedural and device‐related success rates of 100%. In‐hospital target lesion failure occurred in one patient (2.0%) related to postprocedural myocardial infarction. Patient and angiographic characteristics included diabetes, 43.1%; lesion length ≥20 mm, 20.4%; bifurcation lesion, 31.5%; lesion classification B2/C, 74.1%; and baseline TIMI 0/1 flow, 13.0%. No subsequent in‐hospital adverse events occurred. Conclusions: Percutaneous coronary revascularization involving a predilation strategy with a low profile, 1.25‐mm angioplasty catheter is associated with favorable procedural safety and efficacy and may represent an effective initial treatment for complex coronary anatomy. © 2010 Wiley‐Liss, Inc.     

Lesion protection during fixed-wire balloon angioplasty: use of the "buddy wire" technique and access catheters.

Fixed-wire (FW) coronary angioplasty procedures have gained widespread acceptance in some institutions as a primary choice for all angioplasty procedures. These single-lumen, low-profile devices provide distinct advantages as compared to over-the-wire systems in certain circumstances. However, they have not allowed for lesion protection or guidewire access if the situation arises. Two techniques are available to provide lesion protection during FW coronary angioplasty. They are the buddy wire technique and the use of subselective intracoronary access catheters. Access catheters can be used as primary, pre-loaded devices or as secondary devices to be used over an extended FW balloon catheter. These techniques can widen the applications of FW balloon angioplasty.     

Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system

The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.