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Invasive Cardiology Board Review > Guide Catheter Selection for Coronary Interventions > Flashcards

Guide Catheter Selection for Coronary Interventions Flashcards

1
Q

What is one of the most common coronary anomalies?

A

Separate ostia of the left coronary artery or a very short left main artery

Occurs in approximately 1% of patients and must be recognized by the operator.

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2
Q

What is often better than obtaining inadequate angiograms of both vessels?

A

Selectively cannulating and obtaining separate angiograms of the LCx and LAD

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3
Q

What catheter was used to selectively enter the LCx in this case?

A

JL 4 catheter

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4
Q

What is the most likely maneuver to selectively cannulate the LAD?

A

Change to the next smaller Judkins curve size, in this case, JL 3.5

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5
Q

What other maneuvers may allow cannulation of the LAD?

A
  • Withdraw the JL 4 slightly and apply clockwise rotation
  • Use a smaller backup guide like XB 3.0 or EBU 3.5
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6
Q

What does CT coronary angiography help define?

A

The course of anomalous coronary arteries in difficult cases

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7
Q

What is a common technical limitation when treating a distal stenosis?

A

The shaft length of the balloon or stent catheter (typically 135 cm)

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8
Q

How can additional working length be preserved when using a guide?

A

By using a 90-cm guide instead of a longer one

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9
Q

What is ideal for cannulating vein grafts to the RCA?

A

An MP catheter

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10
Q

What is important for radial artery interventions?

A

Adequate guide catheter support

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11
Q

What are the risks associated with larger lumen catheters?

A
  • Increased potential for complications at the puncture site
  • Higher contrast loads
  • More trauma to the aorta
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12
Q

What should be anticipated for guide catheter selection in CTO cases?

A

The need for adequate visualization and support

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13
Q

What is an essential component in planning a rotational atherectomy case?

A

Knowledge of the maximum burr size

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14
Q

What two transcatheter aortic valve bioprostheses are available in the US?

A
  • Edwards Sapien 3 valve
  • Medtronic CoreValve Evolut
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15
Q

What is the design of the Sapien 3 valve in relation to coronary ostia?

A

Designed to be positioned below the coronary ostia

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16
Q

What adjustment is often needed when using Judkins catheters for a right radial approach?

A

JL catheters should be downsized by 0.5 cm

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17
Q

What could help engage the left main ostium when the catheter tip is just inferior to it?

A

Gentle clockwise rotation of the catheter

18
Q

What could be used to reconnect a shortened guide catheter?

A

A piece of sheath 1 Fr size smaller

19
Q

What is a common issue encountered with the Judkins catheter in patients of short stature?

A

The curve size of the Judkins catheter is too large

This can lead to difficulties engaging the left main coronary artery.

20
Q

What maneuver can help engage the left main coronary artery?

A

Gentle clockwise rotation of the catheter while the patient takes a deep breath

This helps to pull the ostium downward as the diaphragm moves.

21
Q

Which catheters are considered ‘longer’ than the JL 4 and may not fit?

A
  • JL 5
  • AL 2
  • Voda 4

These catheters are typically not expected to fit due to their size.

22
Q

Where do saphenous vein bypasses to the left coronary typically arise from?

A

The left anterior surface of the aorta, superior to the native vessels

They usually arise superior to a bypass graft to the RCA.

23
Q

Which catheters often engage left-sided bypass grafts but do not provide robust backup support?

A
  • JR 4
  • LCB

HS and AL catheters provide additional support compared to these.

24
Q

What is the best catheter choice for a type III aortic arch?

A

A Simmons catheter

It requires reformation and manipulation to engage the innominate artery.

25
Q

What is essential equipment requirement when performing rotational atherectomy?

A

The guide catheter must be large enough to accommodate the atherectomy burr

Good flow is also important for debris washout.

26
Q

What is a common challenge when using radial arteries for PCI?

A

Radial arteries can be quite small, potentially not allowing standard 6 Fr sheaths

Operators often report success with 5 Fr guiding systems.

27
Q

What might pressure dampening indicate during angiography?

A

Possible significant left main disease

It should be investigated to ensure no obstructive disease is present.

28
Q

What can diagnostic or guide catheters induce?

A

Ostial coronary artery dissections

This can occur even with mild, insignificant disease.

29
Q

Which catheter shapes provide substantial backup for the delivery of stents?

A
  • Amplatz catheter shape
  • XB family of curves
  • EBU family of curves
  • Voda curves

The JL 4 shape provides minimal backup.

30
Q

What is a challenge when cannulating an anomalous RCA?

A

It is often very challenging to cannulate due to its atypical origin

Standard left catheters may sometimes be utilized.

31
Q

What should be done if a guide catheter becomes kinked?

A

Rotate the catheter in the opposite direction to ‘unkink’ it

A stiff wire may be used to assist in catheter removal.

32
Q

When should the waveform from the guide catheter be monitored?

A

Frequently, especially during maneuvers that could change the guide position

This includes when seating the guide, before injections, and during equipment passage.

33
Q

What catheter should be used for enhanced support with a left-sided SVG?

A

An AL guide (AL 1, AL 1.5, or AL 2)

Alternatively, LCB or HS catheters may provide additional support.

34
Q

What catheter is best for an RCA with an upward takeoff?

A

The AL 1 catheter

Optimal coaxial alignment and backup support are desirable.

35
Q

Which guide is well suited to cannulate both the left and right coronary arteries?

A

The Ikari left guide

It facilitates rapid angiography prior to PCI in STEMI settings.

36
Q

What is the primary purpose of the Ikari left guide?

A

To cannulate and image both the left and right coronary arteries

This facilitates rapid angiography prior to PCI in the setting of STEMI.

37
Q

Why might the AL 2 guide be unsuitable for cannulating the RCA?

A

It is likely too long to cannulate the RCA well

Although it is still possible to use it.

38
Q

Which guide is not able to cannulate the left main?

A

The JR 4 guide

This guide is ineffective for this purpose.

39
Q

What is a limitation of the JL 3.5 guide?

A

It would not easily cannulate the RCA

This limits its effectiveness in certain procedures.

40
Q

What is the EBU 4 guide routinely used for?

A

Left coronary intervention

This guide is commonly utilized in interventional cardiology.

41
Q

True or False: The Ikari left guide is effective for rapid angiography prior to PCI in STEMI.

A

True

Its design facilitates quick imaging and intervention.

Invasive Cardiology Board Review (42 decks)

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