The physics of guiding catheters for the left coronary artery in transfemoral and transradial interventions

Abstract

Background: The backup force of a guiding catheter is important for successful percutaneous coronary intervention (PCI), however, no theory has been proposed thus far regarding the factors involved in its generation.

Methods and results: The backup force of guiding catheters was measured in an arterial tree model. In vitro modeling showed that larger-sized guiding catheters had greater backup force (8 Fr > 7 Fr > 6 Fr). Comparing the backup force between transfemoral (TFI) and transradial interventions (TRI), it was found to be 60% greater in TFI with a Judkins L (JL) catheter, and 8% greater in TFI with a backup (EBU/XB) type catheter. However, the Ikari L (IL) catheter generated a similar backup force between TRI and TFI. In TRI, the Ikari guiding catheter showed the greatest backup force, especially in the power position (power position of IL4 > IL4 > backup type 3.5 > deep engagement of JL4 > JL3.5 > JL4). These findings were associated with the angle of the catheter on the reverse side of the aorta. We then constructed several catheters with varying contact lengths. In vitro modeling showed that a longer contact area increased the backup force.

Conclusions: The present model showed that three factors were associated with backup force: (1) catheter size; (2) angle on the reverse side of the aorta; and (3) contact area. The Ikari guiding catheter comprises all of the preferable factors in TRI.