Guias y Cateteres Guia

1. Guias y Cateteres Guia Carlos E Uribe Clinica Cardiovascular Santa Maria Medellin Colombia

2. Reglas de Oro • Guia adelante del cateter • Manipulacion en el arco aortico • Back Flush vigoroso • Coaxial a la arteria a tratar.

3. Curvas Geometricas

22. Mamario Corto ??

23. Soluciones: • Mamarios de 90 cms (disponibles) • Cambio engorroso • Sobre guia 0.035 de intercambio (300). • Técnica de acortamiento modificada • Cortar el catéter • Adición de introductor (tecnica griega…)

26. Técnicas de Inflado del Balón:Inflado rápido vs. Inflado lento ???

27. : Am J Cardiol. 1994 Feb 1;73(4):228-30.Links • Does the speed of balloon deflation affect the complication rate of coronary angioplasty? • Foster CJ, • Teskey RJ, • Kells CM, • O'Neill BJ, • Fitzgerald N, • Foshay K, • Peck C. • Division of Cardiology, Victoria General Hospital, Halifax, Nova Scotia, Canada. • Two hundred consecutive coronary arteries in 157 patients undergoing angioplasty were randomized to fast or slow balloon deflation. Angioplasty was successful in 188 cases (101 with slow and 87 with fast deflation). There was no significant difference between the 2 groups with regard to the total number of dissections, although there was a greater number in the slow deflation group, and no difference in the number of minor dissections (National Heart, Lung, and Blood Institute types A and B). There was a significantly greater number of more severe dissections (types C to F) in the slow deflation group (20 vs 5; p = 0.013). It is proposed that the greater number of severe dissections is due to either increased turbulence or movement of the partially deflated balloon during slow deflation. Thus, slow balloon deflation during coronary angioplasty is associated with a higher complication rate than is conventional rapid deflation. • PMID: 8296751 [PubMed - indexed for MEDLINE] Coronary dissection resulting from angioplasty with slow oscillating vs. rapid inflation and slow vs. rapid deflation.Cathet Cardiovasc Diagn. 1995 Mar;34(3):202-9. PMID: 7497485 [PubMed - indexed for MEDLINE]Blankenship JC, Krucoff MW, Werns SW, Anderson HV, Landau C et al… Department of Cardiology, Geisinger Medical Center, Penn State Geisinger Health System, Danville 17822, USA. jblankenship@PSGH5.edu Previous studies suggest that slow and/or oscillating balloon inflation during coronary angioplasty may decrease the incidence of coronary dissection and improve clinical outcomes. To compare the effect of slow oscillating versus conventional fast inflation techniques on the incidence of severe coronary dissection during angioplasty, 622 patients were randomized to slow oscillating inflation versus fast inflation. Angiographic outcomes of the procedures and in-hospital clinical events were recorded. The primary end point of severe (type C, D, E, F) dissection occurred in 7.7% of patients undergoing slow oscillation and 6.6% of patients undergoing fast inflation (p = 0.87). Major complications (death, urgent coronary artery bypass graft surgery, stroke, abrupt closure, or Q-wave myocardial infarction) occurred in 4.7% of patients undergoing slow oscillation and 3.5% of patients undergoing fast inflation (p = 0.45). The 2 inflation strategies did not differ in the pressure at which the balloon achieved full expansion, angiographic success rate, residual stenosis, and incidence of all minor and/or major complications. We conclude that there is no benefit of slow oscillating inflation over routine fast inflation in angioplasty. Slow oscillating inflation did not dilate lesions at lower pressures, decrease the incidence of dissection or severe dissection, or reduce the incidence of adverse clinical outcomes.

28. Guias

31. Guias de Segunda y Tercera Generacion Hydrophylic Choice-PT (BSC) Stiff Spring Miracle Bros (Abbott) Cross-It (Guidant) Stiff Hydrophylic Shinobi (Cordis) PT Interm. (BSC)

43. Tecnicas • Anterograda • Retrograda • Tecnica de una sola guia • Tecnica de Doble guia Inyeccion Contralateral.

44. Seleccion de la Guia Consideraciones a la hora de seleccionar una guia. • Respuesta al torque • La punta (respuesta tactil) • Forma de la curva Guias Hidrofobicas • Mejor respuesta tactil al operador • Mejor respuesta y Navega mejor por micro canales • Mejor penetracion en la capa fibrosa “mas nobles”…. Guias Hidrofilicas • Menos feedback tactil al operador, se introduce mas facilmente por disecciones, microcanales etc… • Menos control de la punta, siguen el paso de menor resistencia.

45. Success with precision & control

46. Asahi Confianza Wire Tip diameter tapers down to 0.009” Confianza • The Confianza is specifically designed for HSL that may require a higher penetration ability than the Miraclebros. • Coil tip diameter tapers down from 0.014” to 0.009” to seek micro channels/dimples in HSL • Tip stiffness, 9.0g • Radiopacity = 20 cm • Visibility of full wire length, advantageous in HSL Note: Wire images are not to scale.

47. Asahi Miraclebros Miraclebro Family 3.0, 4.5, and 6.0 • Smooth tractability & delivery with Joint-less spring coils • Core-to-tip design • Excellent tip shapeability & shape retention • Incremental tip stiffness and wire support • 3.0, 4.5 and 6.0 grams of force • Radiopacity = 11cm • Visibility of full wire length, advantageous in HSL Support & Tip Stiffness Least Miraclebros3 Miraclebros4.5 Miraclebros6 Greatest Note: Wire images are not to scale.

48. TORNUS