![]() Guideliner, Guidezilla, Guidion, Trapliner More support is provided with contralateral support guide catheters against the contralateral aortic wall or aortic valveįor the right: Judkins right 4, IMA, Amplatz right, Multipurpose, KR4, IKARI left, Voda right, Amplatz leftįor the left system: Judkins left, IKAR left, Kimny, Voda left, EBU, XB, CLS, SAL, Amplatz left etc. ![]() Starting from less support to maximum support. Multiple available guide catheters available from different companies and for right and left system differences are minimal. Sheathless 7Fr system like RailWay system Radial sheaths 6–7 French several available sheaths: slender sheath most commonly used Multiple sheaths available: pinnacle, bright tip, braided and destinations Table 1 includes a required checklist of equipment needed in any catheterization lab performing PCI, especially high-risk PCI.Ħ–8 French standard (short and supportive long 23, 45, 65 cm for support of a tortuous, iliac and aorta for femoral approach). Reader is redirected to other resources that focus on performing diagnostic left heart catheterization (LHC) as it is crucial to understand everything about diagnostic catheters, procedure, and equipment before proceeding with PCI. This chapter is focusing on PCI technical aspects and high-risk interventions. Knowledge of arterial and venous anatomy and its possible anomalies are basic requirements of any vascular operator. For each approach, operators need to be familiar with the limitations, advantages, disadvantages, access and closure techniques, potential complications, and their management. Carotid, axillary approaches might be necessary in the right clinical presentation. These common approaches include radial right and left, ulnar right and left, distal radial right and left, femoral, and brachial. In reality and especially an emergency situation, any kind of arterial approach that can reach the coronary tree can be used as long as emergency percutaneous coronary interventions could be successfully and safely performed. With each addition to the equipment collection comes a learning curve on both technical and clinical evidence aspects, all which make coronary intervention a more specialized and rapidly progressive field.įor daily planned procedures, there are several approaches for coronary interventions. This created a race to develop a perfect stent that allows for physiological healing of the coronaries and avoid their use in long-term issues. Stent therapy for coronary interventions especially in acute coronary syndrome is a proven concept. While the basics of coronary interventions have not changed, equipment innovation has a very rapid pace with almost daily additions to the arsenal of coronary interventions, in particular, stent development. Thus, mastering all approaches, techniques of PCI, being comfortable with performing high risk PCIs, and using hemodynamic support devices have become very important. With the revolution of percutaneous cardiovascular and valvular interventions, more patients with complex coronary lesions are treated with percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery. This chapter’s goal is to discuss basic to complex techniques summarized to help coronary operators at all levels to understand the practical aspects of daily coronary interventions using a noncomplex approach. The topic of coronary artery intervention techniques is very complex.
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