Coronary Angioplasty Balloon Catheter in Medical Applications

1. Coronary Angioplasty Balloon Catheter in Medical Applications Jagvir Singh MTech. Clinical Engg.

2. History of Coronary Angioplasty • In 1711, Stephen Hales conducted the first cardiac catheterisation of a horse using brass pipes, a glass tube and the trachea of a goose. • WERNER FORSSMAN – First Human Catheterization – 1929 • In the early 1940's, Andre F Cournand, working in New York, began utilizing right heart catheterisation for investigation of cardiac function in both normal and diseased patients. • Andreas Gruentzig– First Coronary Angioplasty - 1977

3. COMPLETE APPARATUS: • > Needle • Guide Wire • Sheath • Catheter

4. PUNCTURE NEEDLES: Used to cannulate or puncture the artery. Usual Sizes include 18 ga, 19 ga , 20ga, 21 ga. The selection of the Size depends on the guide wire going to be inserted through that needle port. Seldinger Needle

5. GUIDE WIRE: • Guide-wire structure : • Available in 35-260 cm length; should be at least 20 cm longer than the catheter to be used • Majority - stainless steel (Majority coated with PTFE (Teflon) • Inner core – Mandrel • Shaft - Coiled wire Safety ribbon / wire – Extends the whole length of coil • All wires have a bead at the tip - soldered.

6. DEFINITION: A catheteris a hollow flexible tube that can be inserted into a body cavity, duct or vessel. Catheters thereby allow drainage or injection of fluids , distend a passageway or provide access by surgical instruments. The process of inserting a catheter is catheterization. In most uses a catheter is a thin, flexible tube: a "soft" catheter; in some uses, it is a larger, solid tube: a "hard" catheter.

7. Ideal characteristics of catheters • Better Torque Control • Strength • Radiopacity • Flexible • Atraumatic Tip • Low Surface frictional resistance for good trackability • over guide wire.

8. PARTS OF A CATHETER BODY • HUB • BODY • TIP TIP HUB

9. FRENCH CATHETER SCALE: The French catheter scale(most correctly abbreviated as Fr, but also often abbreviated as FR or F) is commonly used to measure the outer diameter of cylindrical medical instruments including catheters ,needles etc. D(mm) = Fr/3 or Fr = D(mm)*3

10. CATHETERS CAN BE BROADLY CLASSIFIED UNDER THESE GROUPS: • DIAGNOSTIC CATHETERS • Used for Angiographs . • GUIDING CATHETERS • Used for Angioplasty. • Guiding catheters are like angiography catheters only difference is that guiding catheters are more stiffer & firm as it carries Balloon catheters, PTCA wires and stent delivery system. • Mild stiffness comes due to the wire braided design. • Good Push ability . • Good Tractability.

11. TYPES OF CATHETERS: • CLASSIFICATION : • Catheters can be classified depending on • SIDE HOLES : • -: Single Hole • -:End Hole with side holes. • -:Blocked end with side holes only. • SIZES : • Abdominal – 6-80 cm • Thoracic or Carotid Arteries – 100-120 cm • NOTE: Size depends on : • > age of the patient • > selective or super selective study • > size of the vessels. • NOTE: Ideal practice is to use the smallest diameter catheter feasible for any particular study to minimize the risk of arterial damage by the procedure.

12. TYPES OF CATHETERS • SHAPES • Straight Catheter • Pigtailed Catheter • Cobra Shaped Catheter • Side Winder Catheters (Shepherd)

13. Different Catheter Curves For Different Purposes: > Judkins Left (JL) > Judkins Right ( JR) > Judkins Left Short Tip > Judkins Right Short Tip > Amplatz Left ( AL) > Amplatz Right ( AR) > Left Coronary Bypass > Right Coronary Bypass > Cardiac Pigtail > Multipurpose

14. Judkins Left Judkins Right Amplatz Right Amplatz Left

15. Foleys Catheter (1way, 2way or 3way) Butterfly Catheters

16. Shape of the Tip : J Tip / Straight Tip

17. Some Other Types of Catheters: • Hydrophilic Catheters : • Hydrophilic-coated catheters have a layer of polymer coating that is bound to the catheter surface. • The polymer absorbs and binds water to the catheter, resulting in a thick, smooth and slippery surface. • Intermittent Catheters: • Intermittent catheters are hollow tubes used to drain • urine from the bladder. • Pediatric Catheters: • Usually its around 80cm.

18. Catheter construction : Single layered/Multi layered Multi layered : Inner tube - of Teflon / Polyurethane Middle layer - tube of nylon, woven Dacron, or stainless steel braiding. External layer - A tube of polyethylene or polyurethane is then heated and extruded over the two inner layers to bond firmly . Radio- opaque material is incorporated by impregnating with barium or bismuth Ba, Bi soften the catheter ,may produce fine pitting of surface thereby increasing thrombogenicity Thrombogenicity is reduced by coating with Silicone or any antithrmbogenic materaial

19. Catheters Materials • Dacron ,Polyurethane, Poly ethylene, Teflon, Polyvinylchloride (PVC) • Dacron • Eg. GL - Goodale Lubin, NIH. • Woven Dacron • Most covered with polyurethane coatingto increase surface • stiffness and reduce vascular trauma. • Some angiographic catheters are reinforced with a nylon core.

20. Polyurethane and Poly ethylene(e.g. Judkins Coronary catheters, Pigtail catheters ) • PE is relatively resistant to softening by barium/bismuth and is more easily extruded • can be easily softened by heating for reshaping/special tip configurations • has to be gas sterilized • PU has an excellent memory. This is a desirable feature of super selective catheters whose tip design may be altered during insertion and manipulation. • Softer - which reduces the risk of vascular trauma or perforation. • can be reshaped by immersing in boiling water/or steam • I

21. Teflon • Stiffest vascular catheters. • Teflon has poor catheter memory - more appropriate for non-selective catheterization. • Eg. Mullins for septal puncture / all sheaths

22. Polyvinyl chloride • PVC catheters are the softest among the catheters available. • Very flexible and therefore ideal for flow directed catheters. • PVC has a high friction coefficient which may reduce the ease of catheter passage and increase the incidence of venous spasm. • They have increased thrombogenicity and very poor memory and high moisture absorbtion – drugs may get absorbed Eg - Atropine. • Examples: Swan-Ganz catheters, Berman angiographic catheter.

23. Two types of medical balloons High pressure balloons Moulded to their inflated geometry from non-compliant or low compliant materials that retain their designed size and shape even under high pressure Low pressure balloons Moulded in a tubular shape which is then expanded to several times its original size in use. Used primarily for fixation or occlusion.

24. Balloon Materials

25. Manufacturing Balloons • Angioplasty balloons are made by extruding material into a tube shape and then forming the tube into a balloon through a process known as blow moulding. The balloon should have: – The smallest possible wall thickness – Burst pressure of more than 15 bar – Defined pressure and diameter characteristics

26. USES & APPLICATION s OF CATHETERS: • Placement of a catheter into a particular part of the body may allow: • Draining urine from the urinary bladder as in urinary catheterization, e.g., the Foley catheter. • Catheter balloon Valvuloplasty • Drainage of fluid collections, e.g. an abdominal abscess. • Administration of intravenous fluids, medication or parenteral nutrition with a peripheral venous catheter. • Angioplasty , angiography , balloon septostomy, balloon angioplasty.

27. CONTD… • Direct measurement of blood pressure in an artery or vein. • Direct measurement of intracranial pressure. • Administration of anesthetic medication into the epidural space, the subarachnoid space, or around a major nerve bundle such as the brachial plexus. • Subcutaneous administration of insulin or other medications. • A central venous catheter is a conduit for giving drugs or fluids into a large-bore catheter positioned either in a vein near the heart or just inside the atrium.

28. REFERENCES: • Websites: • Wikipedia • Google • Books: • Diagnostic and therapeutic Cardiac Catheterization : • Carl J.Pepine • Cardiac Catheterization Angiograhy and Instruments: • W. Grossman, Donald Baim • Cardiac Catheterization methods diagnostic and therapeutic: • Peterson ,Nicod