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How to improve guiding catheter back-up in TRI using the IKARI curve - physics of guide catheter -

The IKARI Curves. Technical aspects. Trans-radial approach. How to improve guiding catheter back-up in TRI using the IKARI curve - physics of guide catheter -. T rans- R adial I ntervention. Yuji Ikari, MD, PhD Tokai University, Japan. Yuji Ikari, MD. Background.

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How to improve guiding catheter back-up in TRI using the IKARI curve - physics of guide catheter -

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  1. The IKARI Curves Technical aspects Trans-radial approach How to improve guiding catheter back-upin TRI using the IKARI curve- physics of guide catheter - Trans-Radial Intervention Yuji Ikari, MD, PhD Tokai University, Japan Yuji Ikari, MD

  2. Background • We need sufficient backup support of guide catheters in TRI as well as TFI. • We need to know the mechanism how the guide catheters generate backup force. Technical aspects

  3. Ikari guide catheters Ikari Curves Ikari R (IR) 1.5 Ikari L (IL) 4

  4. If Fcosq≤ l (static friction), the guiding catheter works. If Fcosq > l, system collapses. Hypothesis hypothesis • Thus, Maximun backup force (Fmax) is: l Fmax = ―― cosq IKARI curve

  5. We try to explain several common findings using the hypothesis in the following slides. Experiments

  6. 1. Role of q • If q is larger and close to 90° • the backup force is greater. Results

  7. P<0.05 θr θf Judkins L can generate greater backup force in TFI than in TRI. l Fmax = ―――― cosq Judkins Left TFI vs TRI

  8. θ 3.5 θ4 Judkins L 3.5 can generate greaterbackup force in TRI than JL4. P<0.05 l Fmax = ―――― cosq Judkins Left 3.5 vs 4

  9. θ4deep θ4 Deep engagement increasesbackup force of Judkins L P<0.05 l Fmax = ―――― cosq Judkins Left Deep engage

  10. θj θi Ikari L can generate greaterbackup force than Judkins L in TRI P<0.001 l Fmax = ―――― cosq Ikari vs Judkins L

  11. θi θi Power Position of Ikari L generatesthe greatest backup force P<0.05 Power position Of Ikari L l Fmax = ―――― cosq power position

  12. 2. Role of static friction (l) If the static friction is larger, the backup force is greater.

  13. Considerations aboutthe static friction l Fmax = ―――― cosq Static friction 15mm 25mm 35mm 45mm

  14. Considerations aboutthe static friction l Fmax = ―――― cosq P<0.05 Static friction

  15. 3. Consideration about the brachiocephalic angle Is the brachiocephalic angle responsible for less backup in TRI?

  16. Considerations about the brachiocephalic angle l Fmax = ―――― cosq Brachio- Cephalic angle

  17. Considerations about the brachiocephalic angle n.s. Brachio- Cephalic angle The brachiocephalic angle is not responsible for less backup. However, JL3.5 with angle is easy to engage in TRI.

  18. Summary This new hypothesis can explain several common observations in the manipulation of guiding catheters. l Fmax = ―――― cosq summary • = static friction within the aorta wall F = back-up force

  19. Conclusion • Ikari catheter can generate greater backup force in TRI. • The hypothesis may explain several guiding catheter problems. conclusion

  20. References • Ikari Y, et al. Initial characterization of Ikari Guide catheter for transradial coronary intervention.J Invasive Cardiol. 2004 Feb;16(2):65-8. • Ikari Y, et al. Novel guide catheter for left coronary intervention via a right upper limb approach.Cathet Cardiovasc Diagn. 1998 Jun;44(2):244-7. references

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