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SCAI Chapter 14 PCI equipment guides Flashcards

1
Q

What must guiding catheters accommodate?

A

Guiding catheters must accommodate PCI equipment, enable coaxial engagement, and support the delivery of equipment in obstructed pathways that may be calcified or tortuous

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2
Q

What factors impact the selection of coronary guiding catheters?

A

Selection is impacted by access site, aorta size, coronary vessel, disease complexity, intended PCI devices, bleeding risk, and contrast limit.

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3
Q

How are coronary guide catheters constructed?

A

They are constructed with three layers: an outer lubricious coating, embedded stainless steel mesh, and inner hydrophilic lining.

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4
Q

What is the purpose of the guiding catheter design?

A

The design optimizes the inner diameter to be larger than corresponding diagnostic catheters.

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5
Q

What advancements have been made in PCI?

A

Iterative improvements in angioplasty catheters and adjunctive devices have enabled various combinations of devices to be delivered simultaneously.

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6
Q

What is included in the anatomy of a guide catheter?

A

The anatomy includes: (1) secondary curve ( first curve after shaft) ; (2) primary curve ( second curve after the shaft); (3) stainless steel mesh; (4) atraumatic tip; (5) inner hydrophilic lining; (6) outer lubricious coating.

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7
Q

Illustrate, a typical guiding catheter with annotations.

A
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8
Q
A
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9
Q

What is the internal diameter range for 5 FR guiding catheters?

A

0.56-0.58 inches

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10
Q

What is the internal diameter range for 6 FR guiding catheters?

A

0.70-0.71 inches

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11
Q

What is the internal diameter range for 7 FR guiding catheters?

A

0.78-0.81 inches

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12
Q

What is the internal diameter range for 8 FR guiding catheters?

A

0.88-0.90 inches

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13
Q

What is the external diameter for 5 FR guiding catheters?

A

2.3 mm

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14
Q

What is the external diameter range for 6 FR guiding catheters?

A

2.52-2.6 mm

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15
Q

What is the external diameter range for 7 FR guiding catheters?

A

2.85-3.1 mm

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16
Q

What is the external diameter range for 8 FR guiding catheters?

A

3.2-3.5 mm

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17
Q

Are balloons ≥5 mm compatible with 5 FR guiding catheters?

A

No

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18
Q

Are balloons ≥5 mm compatible with 6 FR guiding catheters?

A

Yes

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19
Q

Are balloons ≥5 mm compatible with 7 FR guiding catheters?

A

Yes

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20
Q

Are balloons ≥5 mm compatible with 8 FR guiding catheters?

A

Yes

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21
Q

Are stents ≥4.5 mm compatible with 5 FR guiding catheters?

A

No

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22
Q

Are stents ≥4.5 mm compatible with 6 FR guiding catheters?

A

Yes

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23
Q

Are stents ≥4.5 mm compatible with 7 FR guiding catheters?

A

Yes

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24
Q

Are stents ≥4.5 mm compatible with 8 FR guiding catheters?

A

Yes

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25
Q

Are 2 monorail balloons compatible with 5 FR guiding catheters?

A

No

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26
Q

Are 2 monorail balloons compatible with 6 FR guiding catheters?

A

Yes

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27
Q

Are 2 monorail balloons compatible with 7 FR guiding catheters?

A

Yes

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28
Q

Are 2 monorail balloons compatible with 8 FR guiding catheters?

A

Yes

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29
Q

Is a combination of 1 monorail balloon + 1 monorail stent compatible with 5 FR guiding catheters?

A

No

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30
Q

Is a combination of 1 monorail balloon + 1 monorail stent compatible with 6 FR guiding catheters?

A

Yes

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31
Q

Is a combination of 1 monorail balloon + 1 monorail stent compatible with 7 FR guiding catheters?

A

Yes

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32
Q

Is a combination of 1 monorail balloon + 1 monorail stent compatible with 8 FR guiding catheters?

A

Yes

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33
Q

Is a wire + 1 microcatheter compatible with 5 FR guiding catheters?

A

Yes

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34
Q

Is a wire + 1 microcatheter compatible with 6 FR guiding catheters?

A

Yes

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35
Q

Is a wire + 1 microcatheter compatible with 7 FR guiding catheters?

A

Yes

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36
Q

Is a wire + 1 microcatheter compatible with 8 FR guiding catheters?

A

Yes

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37
Q

Are 2 microcatheters compatible with 5 FR guiding catheters?

A

No

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38
Q

Are 2 microcatheters compatible with 6 FR guiding catheters?

A

Yes

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39
Q

Are 2 microcatheters compatible with 7 FR guiding catheters?

A

Yes

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40
Q

Are 2 microcatheters compatible with 8 FR guiding catheters?

A

Yes

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41
Q

Is a combination of 1 microcatheter + 1 OTW balloon compatible with 5 FR guiding catheters?

A

No

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42
Q

Is a combination of 1 microcatheter + 1 OTW balloon compatible with 6 FR guiding catheters?

A

No

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43
Q

Is a combination of 1 microcatheter + 1 OTW balloon compatible with 7 FR guiding catheters?

A

Yes

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44
Q

Is a combination of 1 microcatheter + 1 OTW balloon compatible with 8 FR guiding catheters?

A

Yes

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45
Q

Are 2 OTW balloons compatible with 5 FR guiding catheters?

A

No

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46
Q

Are 2 OTW balloons compatible with 6 FR guiding catheters?

A

No

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47
Q

Are 2 OTW balloons compatible with 7 FR guiding catheters?

A

No

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48
Q

Are 2 OTW balloons compatible with 8 FR guiding catheters?

A

Yes

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49
Q

Are 2 monorail stents compatible with 5 FR guiding catheters?

A

No

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50
Q

Are 2 monorail stents compatible with 6 FR guiding catheters?

A

No

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51
Q

Are 2 monorail stents compatible with 7 FR guiding catheters?

A

Yes

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52
Q

Are 2 monorail stents compatible with 8 FR guiding catheters?

A

Yes

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53
Q

Is a combination of 1 monorail balloon + 1 microcatheter compatible with 5 FR guiding catheters?

A

No

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54
Q

Is a combination of 1 monorail balloon + 1 microcatheter compatible with 6 FR guiding catheters?

A

Yes

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55
Q

Is a combination of 1 monorail balloon + 1 microcatheter compatible with 7 FR guiding catheters?

A

Yes

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56
Q

Is a combination of 1 monorail balloon + 1 microcatheter compatible with 8 FR guiding catheters?

A

Yes

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57
Q

Is a combination of 1 monorail balloon + OTW balloon compatible with 5 FR guiding catheters?

A

No

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58
Q

Is a combination of 1 monorail balloon + OTW balloon compatible with 6 FR guiding catheters?

A

Yes

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59
Q

Is a combination of 1 monorail balloon + OTW balloon compatible with 7 FR guiding catheters?

A

Yes

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60
Q

Is a combination of 1 monorail balloon + OTW balloon compatible with 8 FR guiding catheters?

A

Yes

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61
Q

Is IVUS + 2nd wire compatible with 5 FR guiding catheters?

A

Yes

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62
Q

Is IVUS + 2nd wire compatible with 6 FR guiding catheters?

A

Yes

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63
Q

Is IVUS + 2nd wire compatible with 7 FR guiding catheters?

A

Yes

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64
Q

Is IVUS + 2nd wire compatible with 8 FR guiding catheters?

A

Yes

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65
Q

Is IVUS + microcatheter compatible with 5 FR guiding catheters?

A

No

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66
Q

Is IVUS + microcatheter compatible with 6 FR guiding catheters?

A

No

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67
Q

Is IVUS + microcatheter compatible with 7 FR guiding catheters?

A

Yes

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68
Q

Is IVUS + microcatheter compatible with 8 FR guiding catheters?

A

Yes

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69
Q

Is a Rotablator compatible with 5 FR guiding catheters?

A

No

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70
Q

Is a Rotablator compatible with 6 FR guiding catheters?

A

Yes

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71
Q

Is a Rotablator compatible with 7 FR guiding catheters?

A

Yes

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72
Q

Is a Rotablator compatible with 8 FR guiding catheters?

A

Yes

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73
Q

Is a laser (0.9-1.4 mm) compatible with 5 FR guiding catheters?

A

No

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74
Q

Is a laser (0.9-1.4 mm) compatible with 6 FR guiding catheters?

A

Yes

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75
Q

Is a laser (0.9-1.4 mm) compatible with 7 FR guiding catheters?

A

Yes

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76
Q

Is a laser (0.9-1.4 mm) compatible with 8 FR guiding catheters?

A

Yes

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77
Q

Are 3 monorail balloons compatible with 5 FR guiding catheters?

A

No

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78
Q

Are 3 monorail balloons compatible with 6 FR guiding catheters?

A

No

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79
Q

Are 3 monorail balloons compatible with 7 FR guiding catheters?

A

Yes

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80
Q
A
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81
Q

Guide catheter selection for left coronary and normal aortic root.

A

JL4, AL-1, EBU 3.75, XB 3.5, VL4

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82
Q

Guide catheter selection for right coronary and normal aortic root.

A

JR4, AL-1, AR-1, AR-mod, HS or hockey stick

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83
Q

Guide catheter selection for left coronary and dilated aortic root.

A

JL4.5, JL5, AL ≥ 2, EBU/XB ≥4, VL 5 or Voda left

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84
Q

Guide catheter selection for right coronary and dilated aortic root

A

JR ≥ 5, AL ≥ 2

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85
Q

Guide catheter selection for left coronary with smaller route sizes

A

JL3.0-3.5, AL-0.75, EBU 3.5, XB 3, VL 3

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86
Q

Guide catheter selection for right coronary with smaller root sizes

A

JR 3, AL 0.75

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87
Q

Abbreviations used in catheter selection

A

AL, amplatz left; AR, amplatz right; EBU, extra back-up; HS, hockey stick; JL, judkins left; JR, judkins right; VL, voda left; XB, xtra back up.

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88
Q
A
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89
Q

What is the general guideline for using left-sided radial guides compared to femoral access?

A

Similar shapes will work, but the curve must be decreased, often approximately ½ size to achieve coaxial engagement.

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90
Q

What are the normal aortic root sizes for left coronary with Radio access?

A

JL3.5, AL-1, EBU 3.0-3.5, XB 3.0, VL3, IL 4.0

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91
Q

What are the normal aortic root sizes for right coronary via radial access?

A

JR4, AL-1, AR-1, AR-mod, Ikari R or Ikari L 4.0, HS

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92
Q

What are the dilated root sizes for left coronary via radial access?

A

JL ≥ 4, AL ≥ 2, EBU ≥ 3.75, XB ≥ 3.5, XLV ≥ 4

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93
Q

What are the dilated root sizes for right coronary via radial access?

A

JR ≥ 5, AL ≥ 2

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94
Q

What are the narrow aortic root sizes for left coronary via radial access?

A

JL3.0-3.5, AL-0.75, EBU 3.0, XB 3, XLV 3

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95
Q

What are the narrow aortic root sizes for right coronary via radial access?

A

JR 3, AL 0.75, AR-1, AR mod

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96
Q

What is the focus of the guide back up force study via radial access?

A

Comparative backup force of various French guiding catheters with automated balloon advancement in an ex vivo transradial dry model.

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97
Q

How does engagement with a JL4 guide compare to deep engagement?

A

Engagement with a JL4 guide offers less backup support than deep engagement using the JL4 or an extra-backup left guide.

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98
Q

Which guides provided the highest degree of backup support?

A

An Ikari left (IL4) and IL4 with power position using deep engagement offered the highest degree of backup support.

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99
Q

Draw illustration of a backup force when engaging a guiding catheter

A

Cosine of zero equals one and cosine of 90 equals zero. So when theta angle is close to 90, maximum force is quite high ( close to indefinite ) and hence there is maximum support. However, when the angle is very small, then lambda equals maximum force, and since lambda is a static friction, then the system will collapse

102
Q

What is passive support in coaxial delivery?

A

Passive support is derived from material stiffness, guide curve coaxial alignment, contralateral aortic wall contact, catheter size, and angle of contact.

103
Q

How does catheter size affect passive support?

A

Larger catheters are inherently stiffer and offer greater support than smaller guiding catheters.

104
Q

What is active guiding support ?

A

Active support is achieved by guide manipulation to conform to the aortic root or deep engagement of the catheter.

105
Q

What are the caveats to active guide support?

A

Caveats include vessel size and proximal disease, as deep intubation may cause pressure dampening, flow obstruction, and/or vessel dissection.

106
Q

How does guide catheter size impact equipment delivery?

A

Guide catheter size impacts the type and amount of equipment that can be delivered, with larger catheters improving backup force.

107
Q

What are the drawbacks of larger guide catheters?

A

Benefits can be offset by higher contrast volume utilization and higher rates of vascular complications.

108
Q

What limits larger guiding catheter size?

A

Body habitus and access route radial versus femoral, limit guiding catheter size, especially in radial access.

109
Q

What are sheathless guiding catheters?

A

Sheathless guiding catheters allow for a step-up in guide size to accommodate access site (exam 8 French for radial access) but compromise torque control and may be more prone to kinking.

110
Q

What are sidehole guiding catheters designed for?

A

They engage vessels with ostial vessel disease that normally causes pressure dampening , preventing excessive pressurization of the coronary vessel and reduce the chance for hydraulic vessel dissection, and enabling reliable aortic pressure monitoring. In summary, they are ideal for ostial lesions. This is at the expense of higher contrast utilization.

111
Q

What is a key consideration during guide engagement?

A

Coronary flow is reduced during guide engagement despite normalization of pressure waveform, so monitoring for ischemia via other signals remains important.

112
Q

What factors influence guide catheter length selection (90–125 cm)

A

Length selection varies according to vessel distance from access site and equipment length used.

113
Q

When might longer guide catheters be needed?

A

Longer catheters may be required for very tall patients or significant vessel tortuosity.

114
Q

What is the benefit of shorter guide lengths?

A

Shorter guide lengths facilitate cases in bypass grafts and complex chronic total occlusion (CTO) cases.

115
Q

Can guide catheters be manually shortened?

A

Yes, they may be manually shortened by trimming a distal section and reconnecting with a smaller interposed cut sheath.

117
Q

What is the function of Workhorse wire ?

A

Steerable, trackable, good tactile feedback

118
Q

What are some wire for Workhorse?

A

Balanced middle weight,
run through,
sion blue,
pro water,
choice PT

119
Q

What is the function of a polymer jacketed wire or tapered tip wire ?

A

Navigating tortuosity and calcification.

Examples are pilot 50 ( polymer jacketed).

Tapered tip wires like fielder FC, SION black and whisper.

120
Q

What are the wire characteristics of Confianza Pro 12?

A

Good Penetration

121
Q

What are the wire characteristics of Gaia 1, 2, 3?

A

Good Penetration

122
Q

What is the tip stiffness of the following wires?

A

Pilot 200: 4.1 grams,
Gladius 3.0 grams,
Confienza pro 12 : 12.4 gms,
Gaia 1: 1.7 gm
Gaia 2 : 3.5 gm,
Gaia 3 : 4.5 gm

123
Q

What kind of wires do you need for good penetration?

A

Either polymer jacketed like pilot 200
or non-polymer jacketed like Gladius, Confianza pro 12 or Gaia one, two, three, etc.

124
Q

Draw an illustration of different coronary wire elements:

126
Q

What is the core of a wire?

A

The inner structure of the wire that extends from the proximal to distal end,
but not all of the core material reaches the distal wire tip.

Proximally, the core can be made of stainless steel, nitinol, or a composite of the two metals.

127
Q

What determines the properties of the wire core?

A

The composition of the core determines tip load, flexibility, steerability, trackability, and support for performing PCI.

128
Q

How does core thickness affect wire support?

A

Core thickness is proportional to wire support. The thicker the core, the better is the support.

129
Q

What is the relationship between taper length and distal wire tip prolapse?

A

Some cores taper, and the length of the taper is inversely proportional to the propensity for the distal wire tip to prolapse.

The longer is the taper lengths, the lower the chance for the distal wire tip to prolapse.

130
Q

What is a ‘core-to-tip’ design?

A

If the core extends to the entire length of the wire, it is a ‘core-to-tip’ design that lends to increased tactile feedback and near 1:1 torque control.

131
Q

What do wires with cores that do not reach the distal end have?

A

They have a small metal ribbon that provides shape retention, softness, and tip flexibility at the expense of torque control.

132
Q

What is the typical size of wires and their tips?

A

Wires are generally 0.014” (0.36-mm) wires and have 0.014” tips, ( but some have tapered tips (0.10”) examples are Fielder XT )

133
Q

What is the wire body composed of?

A

The wire body is around the core and is composed of coils or polymers.

134
Q

What are hybrid wires?

A

Hybrid wires may have polymer for the body, known as a sleeve, and the distal tip is left uncovered.

135
Q

What benefits do uncovered tips provide?

A

The uncovered tip, better known as spring coils, provides good tactile feedback, shapeability, and shape retention.

136
Q

What is the effect of polymer coating on wires?

A

Some wire may have polymer coating that extends to the tip coils that improves deliverability across calcified or tortuous anatomy at the expense of tactile feedback ( example pilot 50)

137
Q

What types of coatings can the wire body have?

A

The wire body can be coated with an overlay that is hydrophilic or hydrophobic.

138
Q

What are the effects of hydrophilic coatings?

A

Hydrophilic coatings make wires lubricious, thus decreasing tactile feedback but improving navigation through tortuosity and calcium.

139
Q

What are the effects of hydrophobic coatings?

A

Hydrophobic coatings improve tactile feedback but are less slippery and decrease trackability.

140
Q

What is a hybrid design in wire coatings?

A

Hybrid designs exist that combine HYDROPHOBIC TIP coils with hydrophilic intermediate coils to provide tactile feedback with trackability.

142
Q

What is torquability in guidewires?

A

The translation of torque at the proximal end to the distal end for improved steering. The ultimate goal is 1:1 torque control from proximal shaft to distal tip.

143
Q

What does trackability refer to in guidewires?

A

The ability for the rest of the wire to follow and be advanced across stenoses or tortuosity once the distal tip crosses.

This is also known as the deliverability or crossing.

144
Q

What is tactile feedback in the context of guidewires?

A

Transmission of resistance to wire manipulation from distal tip to proximal body.

145
Q

How is tip load defined in guidewires?

A

The load measured by the force required to buckle the tip when applied orthogonally to a standard surface.

Soft wires have low tip loads, while higher tip loads are used for resistant plaque.

Soft wires are frequently used for their atraumatic nature and safety profile .

Higher tip loads are utilized for resistant plaque and frequently CTO.

146
Q

What is the range of tip loads for guidewires? How do you increase a penetration power of a wire?

A

Tip loads may vary from 0.5 to 25 g.

Combining higher tip loads with tapered design will increase the penetration power of a wire.

147
Q

What does support mean in guidewires?

A

Wire support is defined as guidewire‘ resistance to bending.

Wires with more support, assist with device delivery and vessel straightening.

148
Q

What are the typical lengths of guidewires?

A

Wires generally come in short (180-190 cm) or long (300 cm) varieties.

149
Q

What is the purpose of wire extensions?

A

Short wires can be compatible with wire extensions to convert them to appropriate lengths for exchanging longer over-the-wire devices (~135-150 cm).

150
Q

What are specialty extra-long wires designed for?

A

They are specifically designed for externalization during CTO PCI, with extended coating to reduce friction and for greater ease of tracking.

151
Q

What is torquability in guidewires?

A

The translation of torque at the proximal end to the distal end for improved steering. The ultimate goal is 1:1 torque control from proximal shaft to distal tip.

152
Q

What does trackability refer to in guidewires?

A

The ability for the rest of the wire to follow and be advanced across stenoses or tortuosity once the distal tip crosses.

153
Q

What is tactile feedback in the context of guidewires?

A

Transmission of resistance to wire manipulation from distal tip to proximal body.

154
Q

How is tip load defined in guidewires?

A

The load measured by the force required to buckle the tip when applied orthogonally to a standard surface. Soft wires have low tip loads, while higher tip loads are used for resistant plaque.

155
Q

What is the range of tip loads for guidewires?

A

Tip loads may vary from 0.5 to 25 g.

156
Q

What does support mean in guidewires?

A

Guidewire resistance to bending. Wires with more support assist with device delivery and vessel straightening.

157
Q

What are the typical lengths of guidewires?

A

Wires generally come in short (180-190 cm) or long (300 cm) varieties.

158
Q

What is the purpose of wire extensions?

A

Short wires can be compatible with wire extensions ( DOC wire or Asahi extension) to convert them to appropriate lengths for exchanging longer over-the-wire devices (~135-150 cm) out of the body.

159
Q

What are specialty extra-long wires designed for?

A

They are specifically designed for externalization during CTO PCI, with extended coating to reduce friction and for greater ease of tracking.

160
Q

Give an example for a use of a supportive wire.

A

Buddy wire technique is when a supportive second wire is placed in parallel to straighten a vessel and assist with supporting device delivery.

In general, less supportive wires navigate tortuousity better

161
Q

What are the disadvantages of longer wires?

A

Long wires, sacrifice torque control and they are usually difficult to manage. So instead of using a wire extension, trapping techniques are preferable if the guide size is sufficient.

164
Q

What are the two types of commercially available balloons?

A

Over-the-wire (OTW) and monorail/rapid exchange balloons.

165
Q

What is the structure of OTW balloons?

A

OTW balloons have a central lumen for the wire and a separate lumen (hypotube) for balloon inflation.

166
Q

Why has the use of OTW balloons for wire support declined?

A

It has largely been replaced by microcatheters due to improved performance.

167
Q

What is a key feature of monorail balloons?

A

Monorail balloons have a short segment with a lumen for both the balloon and the wire (what we use daily). The short segment allows for lower profile delivery and enables more equipment into a guide.

168
Q

What advantage do monorail balloons provide?

A

They have lower profile compared to over the wire balloons. They facilitate bifurcation and multivessel PCI, allowing more equipment to fit within guiding catheters.

They also allow single operator PCI performance using 180 cm wires within monorail balloons.

169
Q

What is an example of a specialty balloon used for cutting angioplasty?

A

Wolverine (Boston Scientific, Natick, MA).

170
Q

What technology do some specialty balloons use to improve angioplasty results?

A

Adjunctive technology such as lithotripsy (e.g., Shockwave Medical, Santa Clara, CA).

171
Q

What is a specialty balloon designed for dilation of ostial stents?

A

Ostial Flash (Campbell, CA).

172
Q

What are microcatheters?

A

Microcatheters are supportive catheters with a hydrophilic coating and a larger lumen compared to OTW balloons, minimizing friction during torquing.

173
Q

What design feature do many microcatheters have?

A

Many microcatheters have a braided design to resist kinking in tortuous or calcified vessels.

174
Q

What functions do microcatheters support?

A

Microcatheters support wire traversal, facilitate wire exchanges, dilate channels, allow distal drug delivery, and perform contrast injections.

175
Q

What factors vary among commercially available microcatheters?

A

Commercially available microcatheters vary in crossing profiles, torquability, deliverability, and lengths.

176
Q

What is a notable trade-off with smaller catheter crossing profiles?

A

As catheter crossing profiles become smaller, pushability and torque transmission are sacrificed.

177
Q

Which microcatheters are good for navigating small channels?

A

The Caravel, Finecross, and micro-14 microcatheters are good for navigating small channels because of the small crossing profile, but struggle with calcified channels ( less pushability and torque)

178
Q

Which catheters are more supportive and better for calcified channels?

A

Corsair and Turnpike catheters are more supportive, have better torque transmission, and cross calcified channels more easily.

179
Q

Which microcatheters are designed for retrograde collateral crossing?

A

Turnpike LP, Mamba Flex, and Corsair Pro XS are lower profile and specifically designed for retrograde collateral crossing.

180
Q

What is the profile and trackability of the Micro-14?

A

Lowest profile, good trackability

181
Q

What are the lengths and distal crossing diameter of the Finecross?

A

Length: 130, 150 cm; Distal Crossing Diameter: 1.8 FR

182
Q

What are the characteristics of the Caravel?

A

Good crossibility and trackability.

Length: 135, 150 cm; Distal Crossing Diameter: 1.9 FR

183
Q

What is the crossability and trackability of the Corsair Pro XS?

A

Good crossability and trackability

Length: 135, 150 cm; Distal Crossing Diameter: 2.1 FR

184
Q

What is the trackability of the Mamba Flex?

A

Excellent trackability

Length: 135, 150 cm; Distal Crossing Diameter: 2.1 FR

185
Q

What is the trackability of the Turnpike LP?

A

Enhanced crossability and trackability.

Length: 135, 150 cm; Distal Crossing Diameter: 2.2 FR

186
Q

What are the characteristics of the Corsair?

A

Excellent crossability and trackability

Length: 135, 150 cm; Distal Crossing Diameter: 2.6 FR

187
Q

What is the support characteristic of the Turnpike?

A

Supportive catheter

Length: 135, 150 cm; Distal Crossing Diameter: 2.6 FR

188
Q

What is the purpose of the Turnpike Spiral?

A

Supportive catheter for crossing calcified lesions

Length: 130, 150 cm; Distal Crossing Diameter: 2.9 FR

189
Q

What is the purpose of the Turnpike Gold?

A

Supportive catheter for crossing calcified lesions

Length: 135 cm; Distal Crossing Diameter: 2.9 FR

190
Q

What type of catheter is the Twinpass?

A

Dual lumen catheter

Length: 135 cm; Distal Crossing Diameter: 2 FR

191
Q

What type of catheter is the Sasuke?

A

Dual lumen catheter

Length: 135 cm; Distal Crossing Diameter: 2 FR

192
Q

What are the characteristics of the Supercross?

A

Flexible, angled-tip catheter provides directional support

Length: 130, 150 cm; Distal Crossing Diameter: 1.8 FR

193
Q

What are special characteristics of fine cross micro catheter?

A

Low profile, supportive catheter, however, less pushability.

195
Q

What are the two specialty coronary double-lumen microcatheters?

A

Twin Pass (Teleflex) and Sasuke (Asahi Intecc) are designed for buddy wire delivery or distal delivery of intracoronary medications.

196
Q

What are some specific wire techniques used in coronary procedures?

A

Bifurcation wiring, reverse wiring, parallel wiring, and distal delivery of buddy wires after crossing difficult lesions.

197
Q

What is the purpose of guide extenders?

A

Guide extenders increase active support for coaxial delivery of coronary devices in challenging lesions.

198
Q

What is the ‘mother and child’ technique?

A

It enables deep vessel engagement using a softer, more flexible tubular device compared to stiff guides.

199
Q

Name the four guide extensions available in the United States.

A

Guideliner (Teleflex): 5, and 5.5 to 8 French,
Guidezilla (Boston Scientific) with size 6 to 8 French,
Telescope (Medtronic) with size 5.5 to 7 French
and Trapliner (Teleflex) with a size 6 to 8 French.

200
Q

What are the uses of guide extenders besides device delivery?

A

They are usually used for active support for device delivery in torturous and calcified vessels.

They can be used for thrombectomy, focusing contrast injections, and assisting with removal of trapped equipment such as atherectomy burrs.

201
Q

What are some complications of using guide extensions?

A

Vessel dissection, stent deformation or dislodgement, and air embolism.

202
Q

What is the best practice to avoid complications like dissections during guide extension use?

A

Use the catheters to introduce the guide extension into a vessel,
and consider balloon-assisted tracking for tortuous vessels. This is done by inflating a small balloon to cover the edge of the guide extension, and either advancing the guide extension as a unit or advancing the balloon ahead of the guide extension, then inflating the balloon, followed by advancing the guide extension while the balloon is deflating, this is called inch worm technique.

203
Q

What is unique about the Trapliner (Teleflex)?

A

It has a balloon within its lumen for trapping coronary wires and enabling exchange of OTW microcatheters and balloons.

204
Q

What is the Rotablator?

A

The Rotablator is a rotational atherectomy device composed of an egg-shaped diamond-coated burr, except the 1.25 mm size, which is bullet shaped.

205
Q

What sizes are available for the Rotablator?

A

The Rotablator is available in many different sizes ranging from 1.25 mm to 2.5 mm.

206
Q

How is the Rotablator powered?

A

The Rotablator is powered by compressed gas to spin a burr at speeds as high as 200K revolutions/minute.

207
Q

What is used to prevent the Rotablator from jamming or overheating?

A

A lubricant called Rotaglide is mixed and infused through the shaft of the device.

208
Q

What are the two modes of the Rotablator?

A

The Rotablator has a normal mode and a lower spin mode.

209
Q

What is Dynaglide used for?

A

Dynaglide is typically used to minimize friction while traversing guide catheters or vessel tortuosity.

210
Q

What does the Rotablator ablate?

A

The Rotablator ablates calcium antegrade to the burr path.

211
Q

What are the specifications of the wire used with the Rotablator?

A

The wire used is 0.010″ and the tip is 0.012″ designed to prevent the Rotaburr from traveling off the wire.

212
Q

What are the two versions of wires used with the Rotablator?

A

The two versions are the Rotafloppy and Rotasupport wires.

213
Q

When is the Rotasupport wire used preferentially?

A

The Rotasupport wire may be used preferentially to take advantage of wire bias in cases of eccentric calcium or ostial lesions.

214
Q

What is a risk associated with using the Rotasupport wire?

A

The use of the Rotasupport wire is associated with an increased risk of perforation. its use remains selective.

216
Q

What is the CSI Diamondback 360?

A

The Diamondback 360 is an orbital atherectomy device by Cardiovascular Systems Inc that changes the diameter of the crown rotation based on spin speed.

217
Q

What are the spin speeds of the Diamondback 360?

A

The Diamondback 360 operates at two speeds: 80,000 and 120,000 revolutions per minute (rpm).

218
Q

What factors influence the diameter of ablation in the Diamondback 360?

A

The diameter of ablation is influenced by spin speed, crown advancement speed, and duration of ablation.

219
Q

What is the effect of longer spins and slower crown advancement on ablation diameter?

A

Longer spins and slower crown advancement lead to larger spin diameters.

220
Q

How does the CSI device differ from Rotablator in ablation?

A

Unlike Rotablator, the CSI device ablates calcium radial to the crown and does not treat calcium antegrade to the burr.

221
Q

What is the Excimer coronary laser atherectomy (ECLA)?

A

ECLA is a laser device by Philips that uses a xenon-chloride monochromatic exciter laser to produce ultraviolet light bursts at 308 nm.

222
Q

What are the pulse frequencies of the ECLA?

A

The ECLA operates with a pulse frequency of 25 to 80 Hz.

223
Q

How does the ECLA ablate calcium?

A

The ECLA ablates calcium through photochemical, photothermal, and photomechanical methods.

224
Q

What is photochemical energy in the context of ECLA?

A

Photochemical energy can be titrated and is known as fluency.

225
Q

What catheter sizes are generally chosen for coronary interventions with ECLA?

A

Operators generally choose between 0.9 and 1.4 mm catheter sizes.

226
Q

What are the two types of intravascular imaging?

A

The two types of intravascular imaging are intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

227
Q

What information can intravascular imaging provide?

A

Intravascular imaging provides detailed tissue composition, coronary dimensions, lesion length, plaque volume, and vessel diameter.

228
Q

What are the two main types of IVUS?

A

The two main types of IVUS are rotational IVUS catheters (frequency range between 35 and 65 MHz depending on the catheter type) and nonrotating phased array ( Eagle Eye catheter 20 MHz transducer frequency ) of multiple elements.

229
Q

What is a disadvantage of rotational IVUS?

A

Rotational IVUS has higher imaging resolution but may cause potential nonuniform rotational disturbance (NURD).

230
Q

What recent advancements have been made in IVUS technology?

A

Recent updates in catheter technology have decreased the incidence of nonuniform rotational disturbance (NURD).

231
Q

What does OCT use to produce high-definition cross-sectional anatomy?

A

OCT uses near-infrared light to produce high-definition cross-sectional anatomy.

232
Q

How does the resolution of OCT compare to IVUS?

A

The technique offers improved resolution compared with IVUS but with less tissue penetration.

233
Q

What must be injected during OCT interrogation?

A

Viscous media such as contrast must be injected during interrogation. Viscous media DISPLACE blood cells and prevent from obstructing the infrared light from the vessel wall.

234
Q

Why is viscous media injected during OCT interrogation?

A

It is injected to displace blood cells and prevent them from obstructing the infrared light from the vessel wall.

235
Q

What are the names of the two catheters that perform OCT?

A

The two catheters on the market that perform OCT are the Dragonfly (Philips) and Vis-Rx (Nipro, Bridgewater, NJ).

236
Q

What is the purpose of placing wires in both the side branch and main vessel during provisional stenting?

A

To provide a marker for rewiring in case of side-branch occlusion, assist in anchoring the guiding catheter, facilitate access to the side branch, and allow passage of a small balloon behind the main vessel stent struts if needed.

237
Q

What factors influence the decision to wire a side branch?

A

The area of myocardium supplied by the side branch, lesion complexity, and the degree of disease in the ostial/proximal side branch.

238
Q

What is the Proximal Optimization Technique (POT)?

A

A technique where the stent is sized to the distal vessel and consideration is given for postdilation of the stent proximal to the bifurcation.

239
Q

What should be considered when placing the proximal edge of the stent?

A

Enough stent length must be present to allow for POT, with a minimum length determined by the shortest available balloon length (usually 6-8 mm).

240
Q

How can the proximal vessel size and POT balloon size be determined?

A

By quantitative coronary angiography, intravascular imaging, or Finet’s formula.

241
Q

What type of balloon should be used for POT?

A

A noncompliant balloon, ensuring the distal edge is inflated just proximal to the carina.

242
Q

What is ‘jailing’ in the context of stenting?

A

Leaving the side-branch wire in place while performing main vessel stenting and POT.

243
Q

What are the concerns associated with wire jailing?

A

The possibility of wire damage and fracture when removing jailed wires.

244
Q

What did a study suggest about polymer-coated wires?

A

They are more resistant to retrieval damage and more efficient in crossing the side-branch ostium than nonpolymer-coated wires.

245
Q

What potential benefit was suggested by the COBIS III registry regarding wire jailing?

A

Significantly lower rates of side-branch occlusion in patients with a side branch or main vessel stenosis ≥60%.

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