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LỰA CHỌN CATHETER VÀ DÂY DẪN CAN THIỆP MẠCH VÀNH (Guiding & wire selection) TS Nguyễn Cửu Lợi Trung tâm Tim mạch BV Trung Ương Huế Roles of guiding catheter & guidewire Guiding catheter: Injection of contrast & medication Delivery of devices Guidewire: Crossing the lesions Requirements: Stablization Support Specific to lesions GUIDING CATHETER Guiding catheter selection Variables Requirements - Asc Aorta size - Location of ostia - Vessel course - Enough accomodation - Coaxial intubation - Adequate support = backup Inner diameter Smaller as possible Enough large Minimize vesel trauma Accommodate devices Combined profile of balloons + 0.006” Left main lesions Risk of occlusion and dissection Coaxial Ostium lesion: no backup Small and short-tip Judkins left Guiding catheter for LAD lesions No backup & Normal take-off Guiding catheter for LAD lesions with backup Guiding catheter for LAD lesions from right radial artery Guiding catheter for LCx lesions Short LM No-acute bifurcation LAD Judkins left Long LM Acute bifurcation backup Some conflicts High torque control Increased torque control Steerability ↔ Less supportive Support Straighten vessel Less steerable ↔ More flexibility Concrete cases LAD: less tortuous lesions Transition point between flexible tip and more rigid body is not a major problem Preshaped curve or tiny curve LCx: Broad curve (enter LCx) and shorter curve (cross lesion) Gradual transition would help RCA: - Normal origin: conventional soft wire with good steerability - Anterior arising: improved tip transition, placed as distally as possible Chronic total occlusion • Increased stiffness & excelent torque control, tiny curve (distal force applied to the wire tip = 3g) • “Resort”: Asahi (Intecc, Japan) Miracle series (3-12g), Conquest and Conquest Pro (tapered tip # 0.009 in / 9g), Cross-it XT series (tapered tip # 10 in./ 3-20g) • Last “terminator” - Hydrophylic-coated: : Whisper, Pilot series (Abbott), Crosswire (Terumo), Shinobi / Plus (Cordis) SOME SPECIAL GUIDEWIRES SOME SPECIAL GUIDEWIRES Crossing stent strut into side branch • Friction by the stent strut, prolapse of wire into the main branch • Greater tip strength • First: Universal or available wire • Then: Rinato/Prowater (Asahi) , Intermediate • Finally: fix-wire balloon (ACE balloon-Boston Scient.) Lesions with heavy calcification • Firstly: Universal • Then: Floppy hydrophylic (Whisper, Pilot 50/Abbott, Choice PT/Boston, Fielder/Asahi with over-the-wire balloon • With rotablator: Rotawire (floppy or extra-support) • “Buddy” wire (supportive): to advance the stent Iron Man (Abbott) • Occasionally: Wiggle (Abbott) with “zig-zag” bends 6cm from the tip Rotawire In, or beyond, a very tortuous or angulated segment • • • • • • # Calcified lesions Hydrophylic wires: Whisper (Abbott) Buddy wire or even a buddy balloon Wiggle wire Stabilizing catheter: Buddy wire in another vessel Last resort: Deflectable tip wire (Steer-it / Cordis, Venture / St Jude) Wire-tip curve Presentations of guidewire Presentations of guidewire CONCLUSIONS • Guiding catheter selection: Anatomy of ascending aorta Coronary ostia and vessel course Size - Support • Guidewire selection: Lesion characteristics Tactile experience Thanks for your attention