Transcription
Hello. Welcome, all coming onto the session four of Integrate C2 Academy. In this session, I will be discussing in brief about the coronary microcatheters that are commonly used because they have got a lot of use while we are uh doing the CCII. So, uh, in PCI, many times support is an issue, and in integrated wire escalation, many times we require a good backup support, and it comes in the form of a large guide catheter. Long sheaths can be used, dual lumen catheters, and anchor balloon technique as well as guide catheter extension used. And out of these, most important is the microcatheter. So they provide not only this lateral support as well as they help in negotiating the uh this channels uh or retrograde after collateral channel dilation, like in the form of cost access is available.
So there are a lot of microcatheters available, but I would be focusing mainly on the most commonly used microcatheters, that is FineCross, Carel, and Corsair Pro XCS especially. So FineCross is one of the most common used microcatheters, and it has got a uh stainless steel braid with a gold marker, which is a radiopaque tip, and the tip entry profile is 1.8 French, and the proximal shaft is 2.6 French. It has got a hydrophilic coating, and the inner lining is BTF lining, and it comes in the two usable lengths, that is 130 cm for antegrade approach and 150 cm for the retrograde approach. And this is one of the most commonly used microcatheters, and uh again uh uh this has got a tapered non-tapered; it it has got a tubular non-tapered tip, and it is best having a good lumen. It is best for tipping, as as rondu technique that I've discussed in the RRC Academy. Although it provides a low active backup and uh it has less support, that is th it is not a first choice for the complex CTO or calcified CTO because it is not going to give that active backup or lateral support. Out of this, it has a distal 13 cm which is having an easy advancement and access to uh the channels. It uh can be used sometime in TWAs distal as well as epicardial collateral because it is less prone to causing damage to the collateral. So this is the case in which the FineCross catheter was used in the antegrade approach.
Now next comes the Caravel microcatheter. It is also having a braided shaft. It has an Act One Precision braid. The entry profile is much better as compared to the FineCross, that is 1.4 French, although this the proximal shaft is is almost similar to 2.6 French. Uh, it has also got a hydrophilic coating, and that is uh 70 cm in 135 cm length and 85 cm in 150 cm length, and usable length for antegrade approach is uh this 135 as compared to 150 cm for the retrograde. So for retrograde arm gear, we should use a longer stent microcath. So this has a Caravel has a special characteristic like 1.4 French tip entry profile. Our diameter of the distal shaft is 1.9 French, and proximal is similar to the FineCross, that is 2.6 French. It has a hydrophilic coating of 70 and 85 cm in 135 and 150 cm respectively. It is both useful for antegrade as well as the retrograde approaches, and it can be used in both septal as well as epicardial vessels, and it is a very safe microcatheter and can be used for the epicardial collateral CTO collaterals, and it can be slightly rotated, although it is not meant as a channel dilator, but it can be sometimes rotated but less than 360° in my direction. And what is important is it having an Act One Precision braid, and that provides its resistance to the kinking in the tortuous anatomy, especially when we are going with the epicardial vessels. And two Caravel catheters fit in a 7 French guide, and while doing the IAS, it can be used with IAS catheter in a 7 French guide.
So this is a case where we can see we tried the ostial CTO, but it is ostial calcified CTO, and it is filling retrogradely with the collaterals from epicardial collateral from the OM. So in this, we can see this uh microcatheter Caravel uh is seen in this view, and we negotiated it across this tortuous collaterals, and with the knuckle wire technique, knuckle cut, we were able to successfully open this uh CTO by epicardial dilation. So this Caravel is very useful, especially in the setting of the uh this epicardial collaterals. So this is what the end result of that led CTO was, and we could see there is an epicardial collateral; we can see in the last channel. So this was a connection between the OM and the distal LAD, and through this this Caravel catheter helped. And one of a very important microcatheter that we often use is called Corsair Pro Access. Initially, Corsair was developed, then came the Corsair Pro, and the latest one is the Corsair Pro XCS, and it is one of the most useful micro; I should say because it can be used in both uh most of the complex situations, and we can see it has a purple this hub which has some spiral appearance. So this differentiates it from the various microcatheters, and it is used in complex PCI in very tight and calcific lesion as well as it is useful in crossing the CTO by rotation, and we should rotate in one direction uh 10 turns, and then we can move it to the clockwise or anticlockwise to the opposite direction, then rotation further, and with the left hand we keep on pushing the tip of the microcatheter. And a Corsair Pro XCS who can come in the 7 French guide uh or along with the IAS, it can come in the 8 French guide. So it is one of the most common used microcatheters nowadays, and there's a bit difference among these in as compared to, and I should say this has the smallest profile, that is 1.3 French, although the proximal segment is having uh this profile is 2.9 French, but the distal tip is 1.3 French, and it is different from Corsair Pro. Corsair Pro XCS has a this distal shaft profile of 2.1 as compared to the 2.6 French in case of Corsair Pro. So it it can be it is more of a tapering, and it can be very well negotiated across septal collateral. It acts also like a channel dilator.
So uh just summarizing this Corsair Pro XCS, it has a tip entry profile of 1.3 French. So out of this FineCross, Caravel, and Corsair Pro XCS, Corsair Pro Access has got the thinnest profile, that is 1.3 French. Distal shaft is 2.1 French, and proximal shaft is 2.9 French, although it's a bit 3 French higher as compared to the FineCross of course, this Caravel, but the most important is a tip entry profile is 1.3 French, and this can come along with IAS catheter in an 8 French guide, and uh this is stainless steel Act One shaft which has 14 wires. This is present in this, and this gives a strength as well as rotational properties. So uh this uh Corsair Pro Access has a hydrophilic coating of 70 cm and 85 cm in 135 and 150 cm respectively. The longer one is used for the retrograde approach, and more uh important thing is the rotation. If we are across septal channel, then goal, then we can uh make uh we can move it till the maximum place it goes, and if it stops then we need to rotate in one direction while the clockwise, and once the 10 rotations are up then we can of course change into the different direction going from clockwise to the anticlockwise. And this is the one microcatheter which can be of course in used in very complex CTOs, especially calcified ones, and it has got a tapered soft tungsten marker, that is it has a polyurethane low profile tip, so it gives radiopacity as well as the negotiating power to the microcatheter, and this is one of the most commonly used microcatheters, especially for septal.
So this is the case where ostial RCA CTO was a failed CTO elsewhere, and from LAD we can see a good CTO collateral. After collaterals are going to the distal RCA PD connection there. So we took a C-wire over this; we can see we took a Corsair Pro ACS microcatheter because we knew that this will help as a channel dilator as well as it will can be negotiated to call the septal collateral. So this is how this microcatheter was taken through the septal collateral, and it reached the distal RCA, but there was some bend. So at this place we have to give some uh this clockwise 10 turns and anticlockwise, and it was gradually moved to the mid of the RCA, and after that intracoronary tipping was done, and thus the PCI was done successfully of the RCA. So this was the end result after. So this is how uh we discussed the judicious use of the FineCross, Caravel, and this Corsair Pro XCS. So these are one of the most common microcatheters that are available nowadays, and they have led to a a more increased success of the uh this CTO, either it may be antegrade or retrograde. So we have to keep in mind in which case which microcatheter to take, and that is going to help us very much. So thank you all uh for patient listening, and we'll be discussing the next topic in the coming next session. Thank you.