Access Flashcards
Standard access vs Tri-axial access
Standard: Short Femoral Sheath, Standard Guide Catheter, Microcatheter, Guide Wire
Tri-axial: Long Sheath, Intermediate catheter, Microcatheter, Guide wire
Initial Femoral Artery Guide Wire size?
.035”
What is OD measured in?
French (F)
What is length measured in?
Centimeters (cm)
What is ID measured in?
Inches (in)
Minimum Clearance definition
The minimum amount of space you must have left over on the sides of the catheters to inject contrast or flush saline
Parallel technique definition
Putting two catheters side by side inside of another catheter
Total catheter length = ?
Working length + Strain relief + hub
(Strain relief + hub = 6)
Catheter Stability
The ability of the catheter to stay within the aneurysm (or in place)
Catheter Trackability
Measure of how the catheter navigates over the wire and within the anatomy
Pushability
Measure of the amount of force transmitted to the distal end of the catheter when push force is exerted at the proximal end
Tip softness
The amount of force the catheter tip exerts against the vessel before buckling
Kink resistance
How well the catheter maintains its lumen when in a bend
Tip shapeability
The ease with which the catheter tip takes a specific shape when steam or heat is applied
Shape retention
The ability of the catheter tip to retain steam-shaped or pre-shaped configurations
Durometer
The stiffness of the catheter material.
Higher durometer=improves shape retention & stiffness
Lower durometer=increases softness & flexibility
Taper
Varies the thickness if the microcatheter wall.
Thinner wall= softer, more flexible
Thicker wall= better shape retention
Basecamp definition
-Guide catheter or long sheath typically places in the common carotid or proximal ICA.
-Greater than or equal to 5F.
-“base” conduit for smaller delivery catheters
Guide catheters:
-Balloon, standard, & intracranial guide catheter.
-standard access
-sized by OD (COD: Catheter OD)
Stryker: Guider Softip Guide Cath., Merci BGC, Flowgate2 BGC
Long Sheaths:
-Tri-axial approach
-sized by ID (SID: Sheath ID)
Stryker: AXS Infinity LS (Plus)
What are some stryker intermediate catheters?
Cat 5,6,7
Vecta 71,74
DAC family
3 goals of intermediate catheters:
-Reach the target
-Provide distal stability
-Smooth device delivery & direct aspiration when needed
4 Goals of a microcatheter:
1) reach target site
2) maintain stable positioning
3) offer low friction & large lumen
4) provide a fluoroscopic reference
Stryker microcatheters:
Excelsior SL-10
Excelsior 1018
Excelsior XT17 & XT27
Trevo pro 14 & 18
Trevo Trak 21
Reinforcement
Provides catheter support, stiffening it for increased pushability, and helps improve kink resistance
PTFE lined inner lumen
Enhances smooth delivery of devices within Microcatheter lumen
Hyrdrophilic coating
Facilitates advancement through challenging anatomy
True or False: intermediate catheters improve distal navigation and better 1:1 handling of the guide catheter
False: it helps improve distal navigation and better 1:1 handling of the microcatheter
Which is not a common design of a microcatheter?
A) ptfe lined inner lumen
B) hydrophilic coating
C) edgeless tip
D) radiopaque markerbands
C) there are no edgeless tips however they are steam-shapeable
3 key messages of AXS Infinity LS?
1) rapid access
2) stable platform
3) large .088in lumen
3 key messages of AXS Infinity LS Plus?
-Distal for more support
-reliable in challenging anatomy (14.5mm flex zone)
- fit more inside (.091”) (without increasing OD)
Which of the following can be delivered though AXS Infinity LS Long Sheath?
Trevo nxt + cat 6
Surpass evolve + cat 5
Target coils + transform
All of the above
3 key messages for Cat 5 (115cm)
1) Superior trackability
2) Stable delivery
3) Reliable Design
3 key messages for CAT 5 (132cm) & CAT 6?
1) superior trackability
2) resilient & reliable
3) optimized for stroke intervention
3 key messages for Cat 7?
1) transitionless reinforcement (smooth trackability)
2) .068 ID (more aspiration power to injest clot)
3) compatible with Flowgate2 BGC
CAT 7 has ______, designed to _______
A) an edgless (rounded) tip; for smooth Trevo retrieval
B) a tapered tip; smoothly navigate tortuosity
C) an edgless (rounded) tip; smoothly navigate tortuosity
D) a tapered tip; for smooth Trevo retrieval
A) CAT 7 has an edgeless (rounded) tip, designed for smooth Trevo Retrieval
Steam shapeable/Pre-shaped tip
Enhances vessel selectivity and helps maintain position in aneurysm during coil delivery
Transparent hub
Allows direct visualization of device and guidewire introduction (microcatheters)
Precisely placed markerbands (microcatheters)
Allows user to locate microcatheter and facilitate proper detachment of coils & other devices
What is Excelsior 1018 known for?
Broad Compatibility
(accommodating different GW & facilitates to the majority of anatomical locations)
What is SL-10 known for?
Optimized flexibility
(access distal vasculature & have broad device compatibility - delivers target coils and atlas stents)
What is Excelsior-XT 27 designed for?
Accurate deployment
(Easier access, improved stent deployment, superior stent deployment accuracy)
What is XT-17 known for?
Versatile platform, smooth tracking & stable delivery
(Good for delivering contrast agents, target coils, atlas stents)
Guidewires are used to:
-track through vasculature
-access small distal arteries and/or aneurysms
-cross clots or lesions
-support delivery of interventional devices
Torque
Force required to rotate an object about an axis
Tactile feedback
How the device feels and responds to maneuvering by the operator
5 building blocks of guidewires:
1) Coating
- lubricious substance that coats the wire to decrease surface friction
2) Cover
- The cover or jacket placed over the distal tapered section of the core of the wire
3) Core Taper
- The grind of taper applied to the distal end of the core wire metal
4) Core Diameter
- The diameter of the guidewire at its full untapered or ground down size
5) Core Material
- Metal used to create the base or “core” of the guidewire
3 common core materials:
1) NiTi (nitinol titanium)
2) Stainless Steel
3) a hybrid of NiTi & S.S.
3 types of core tapers:
1) Linear (more supportive)
2) Step Taper (moderate support)
3) Multi-Step Taper (more flexible)
Synchro2 Guidewire benefits?
1) innovative torque control
2) reliable stability & flexibility
3) standard, soft & support profiles
Which of the following coatings are on Synchro2 guidewires?
A) hydrophilic coating on distal 50cm
B) hydrophilic coating on prox 50cm
C) PTFE coating on the prox shaft
D) PTFE coating on the distal shaft
E) it is uncoated
A & C
Hydrophilic coating on the distal 50cm & PTFE coating on the proximal shaft
Select all that create Synchro2 guidewires soft tip:
A) tapering the core wire down to .002in
B) increasing the number of slits in the hypotube
C) decreasing the number of slits in the hypotube
D) tapering the core wire down to .005in
A & B
Tapering the fore wire down to .002in & increasing the number of slits in the hypotube
True or false: the microfabricated distal nitinol hypotube and gentle tip technology are included in all Synchro2 guidewires.
True
True or false: the synchro2 soft guidewire has a softer tip than the synchro2 support
False
The 215cm access length Synchro2 guidewire come in which of the following support profiles?
-Standard
-Soft
-Support
Support
What level of guidewire support is needed for each catheter system?
A) stent retriever w/ Cat6
B) Coil case w/ SL-10
C) Aspiration w/ Vecta 71/74
A) Medium
B) Low
C) High
Which of the following Synchro2 guidewires was designed to ease trackability of large bore catheters?
Synchro2 soft
Synchro2 Standard
Synchro2 Support
Synchro2 Support
Which of the following do you think are benefits of having a more supportive guide wire?
A) Better rail over which to deliver large bore catheters
B) lifting the catheter away from branching arteries
C) Easier to torque
A & B
Better rail over which to deliver large bore catheters & lifting the catheter away from branching arteries
Easier to Torque is not a benefit
Synchro Select 3 benefits:
1) improved tip shape retention
2) softer tip
3) overall enhanced control
Synchro Select Soft used for:
-Better torque control
-navigation of distal anatomy
Synchro Select Standard used for:
-a workhorse for most cases
-excellent control & trackability
Synchro select support used for:
-large/stiff device delivery
-large bore aspiration catheters
How was tip shape retention enhanced on synchro SELECT?
A) improving the core wire processing
B) updating the cut pattern on the nitinol hypotube
C) both A & B
C) both A & B
Improving the core wire processing & updating the cut pattern on the nitinol hypotube
Synchro select has a __% softer tip than Synchro 2
A) 22%
B) 12%
C) 34%
A) 22%
T or F: the pre shaped profiles of Synchro SELECT can be further shaped by physicians
True
T or F: Synchro Select Support has a stiffer tip than Synchro Select Soft.
False
If it navigates better it has a stiffer tip
Which of the following enhancements leads to overall improved control? (Select all that apply)?
A) reversing helix cut pattern
B) conventional technology
C) improved core wire
A & C
Reversing helix cut pattern & improved core wire
Synchro SELECT access length is?
A) 200cm
B) 215cm
215cm
Which Synchro SELEXT profile should you choose for the best possible microcatheter trackability?
A) Soft
B) Standard
C) Support
C) Support
Which Synchro SELECT profile should you use for the best possible Torque?
A) Soft
B) Standard
C) Support
A) Soft
Synchro SELECT has improved tip shape retention compared to Synchro2. By how much have we reduced the tip shape loss?
A) 18%
B) 20%
C) 28%
C) 28%
