Guide Catheters

Question 1

Functions of a Guide Catheter

Answer 1

• Support for device advancement
• Conduit for device and wire transport
• Vehicle for contrast injection
• Measurement of Pressure

Question 2

Important Features of Guide Catheters

Answer 2

• Atraumatic tip
• Preformed curves & configurations
• Torque control
• Kink resistance
• Radiopacity
• Support
• Device Compatibility

Question 3

Guide Catheter Configurations

Answer 3

JL, SL, FL, JCL, VL, GL, XB, JR, FR, SR, SCR, JCR, DA75, DA90, VR, AL, SAL, AR, ALR1-2, CAS, MB1, HS, EL Gamal, DC, LCB, RCB, IMA, EBU

Question 4

Curve Selection Considerations

Answer 4

• Anatomical Approach
• Access Site Issues
• French Size Influence
• Active vs. Passive Support
• Aortic Width
• Coronary Anatomy
• Native Coronary vs. CABG/IMA
• Location and Severity of Lesion
• Amount of Calcium in Target Vessel

Question 5

French Size Influence:

How have guides historically and currently worked?

Answer 5

• Historically, 8F guides were necessary to deliver devices because of their larger internal lumens.
• Current 6-7F catheters have internal lumens just as large as previous generation 8F catheters.

Question 6

What do small French size guides require?

Answer 6

•Small guides require ‘back-up” curves more frequently for added support.

Question 7

What do Large French size guides require?

Answer 7

•Large guides require side-holes more frequently to improve perfusion.

Question 8

Pros and Cons of 6F guide catheters

Answer 8

PROS
•Small arterial puncture
•Brachial/radial access
•Permit active support
•Less contrast

CONS
•Smaller Internal Lumen
•Less Visualization

Question 9

Pros and Cons of 7F-8F guide catheters

Answer 9

PROS
•Better passive support
•Better visualization
•Better torque transmission

CONS
•Larger arterial puncture
•Pressure dampening
•More contrast

Question 10

What does backup support do for guide catheters?

What are the two different Methods of support?

Answer 10

• The ability of the guiding catheter to remain in position and provide a stable platform for the advancement of interventional equipment.
• There are two methods of support:
• Passive Support
• Active Support

Question 11

What is Passive support and what does it do?

Answer 11

Passive support user typically:
•Relies on properties of the shaft and tip to maintain position in the ostium
•Support provided by either anatomy or catheter composition/curve shape
•Rarely deep-seats the catheter
•Minimal manipulation of the guide is required

Question 12

What is Active support and what does it do?

Answer 12

Active Support user typically:
•Uses aortic root to form desired curve shape and provide backup support
•Relies on active manipulation of guiding catheter to:
•Obtain stable position
•Seat coaxially
•Pre-select LAD or LCX
•Rotates the catheter and/or actively engages the catheter (deep-seating maneuver)

Question 13

What is the difference between Active support and Passive support?

Answer 13

Active Support:
•Requires large ostia, unless side holes are used
•Requires disease-free ostia

Passive Support:
•Requires precise curve selection and sizing
•Take-off orientation must match curve
•Width of aorta must match curve

Question 14

Who devised the French gauge and who defined the diameter times 3 relationship?

Answer 14

The French gauge, or scale, was devised by Joseph-Frédéric-Benoît Charrière, a 19th-century Parisian maker of surgical instruments, who defined the “diameter times 3” relationship.