Use of microcatheters and extension devices

GUIDE EXTENSIONS

Support of the guide can be improved by the use of a larger calibre guiding catheter or of catheters with strong back-up support. In addition, the stability of the guide can be improved by advancing a buddy wire, use of a stiffer wire or anchoring balloons. Another way to increase support is deep intubation with the guiding catheter. The last technique is more commonly used with small 5 or 6 Fr guides and is prone to failure or vessel damage when used in vessels with angulated origin or proximal disease.

A safer alternative to deep intubation with the guiding catheter is the use of a smaller guiding catheter inside another. This is called the mother-and-child technique. It led to the development of straight flexible catheters such as the Heartrail® (Terumo Corp., Tokyo, Japan) and rapid exchange guide catheter extensions such as GuideLiner® (Teleflex Inc., Wayne, PA, USA), GUIDEZILLA™ (Boston Scientific, Marlborough, MA, USA), Guidion™ (IMDS, Roden, the Netherlands).

3.1 Heartrail®

This system involves the insertion of an extra length 5 Fr guiding catheter into a standard 6 Fr guide catheter, with the tip of the 5 Fr catheter protruding beyond the 6 Fr guide catheter. The Heartrail is 120...