Guiding Catheters

  • Dushen TharmaratnamEmail author
  • Martin T. Rothman
  • Ajay Jain


As part of a knowledge-based approach to undertaking percutaneous coronary intervention (PCI), appropriate selection and use of guiding catheters is a fundamental cornerstone in the training and performance of cardiovascular interventions. Correct decision making pertaining to the selection of guiding catheters is recognized as one of the most significant determinants of the success of any interventional undertaking, particularly PCI. Acquisition of cognitive and technical skills required for the development of guiding catheter strategies is critical to successful treatments; hence the aim of this chapter is to provide basic knowledge of guiding catheters, including practical tips on usage.

The differences in functionality between diagnostic catheters and guiding catheters are outlined, with particular reference to their respective design features. Types of guiding catheter, especially with regard to the sizes and shapes currently available, are described in general and in subsequent sections elaborated upon with respect to the selection of appropriate guiding catheters according to the intended target vessel, route of arterial access, patient anatomical factors, and type of interventional devices required. We hope this chapter will enable mastery of a good guiding catheter strategy and technique, as tailored to the individual case, and prove ultimately beneficial to the care of patients.


  1. 1.
    Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Aptecar E, Pernes JM, Chabane-Chaouch M, Bussy N, Catarino G, Shahmir A, Bougrini K, Dupouy P. Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA study. Catheter Cardiovasc Interv. 2006;67:711–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Bertrand OF, Rao SV, Pancholy S, Jolly SS, Rodes-Cabau J, Larose E, Costerousse O, Hamon M, Mann T. Transradial approach for coronary angiography and interventions: results of the First International Transradial Practice Survey. JACC Cardiovasc Interv. 2010;3:1022–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Brueck M, Bandorski D, Kramer W, Wieczorek M, Holtgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009;2:1047–54.CrossRefPubMedGoogle Scholar
  5. 5.
    Burzotta F, Trani C, Hamon M, Amoroso G, Kiemeneij F. Transradial approach for coronary angiography and interventions in patients with coronary bypass grafts: tips and tricks. Catheter Cardiovasc Interv. 2008;72:263–72.CrossRefPubMedGoogle Scholar
  6. 6.
    Dahm JB, Vogelgesang D, Hummel A, Staudt A, Volzke H, Felix SB. A randomized trial of 5 vs. 6 French transradial percutaneous coronary interventions. Catheter Cardiovasc Interv. 2002;57:172–6.CrossRefPubMedGoogle Scholar
  7. 7.
    De Bruyne B, Stockbroeckx J, Demoor D, Heyndrickx GR, Kern MJ. Role of side holes in guide catheters: observations on coronary pressure and flow. Catheter Cardiovasc Diagn. 1994;33:145–52.CrossRefGoogle Scholar
  8. 8.
    Dunning DW, Kahn JK, Hawkins ET, O’Neill WW. Iatrogenic coronary artery dissections extending into and involving the aortic root. Catheter Cardiovasc Interv. 2000;51:387–93.CrossRefPubMedGoogle Scholar
  9. 9.
    Eichhofer J, Horlick E, Ivanov J, Seidelin PH, Ross JR, Ing D, Daly P, Mackie K, Ridley B, Schwartz L, Barolet A, Dzavik V. Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J. 2008;156:864–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Elgharib NZ, Shah UH, Coppola JT. Transradial cardiac catheterization and percutaneous coronary intervention: a review. Coron Artery Dis. 2009;20:487–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Grossman PM, Gurm HS, McNamara R, Lalonde T, Changezi H, Share D, Smith DE, Chetcuti SJ, Moscucci M. Percutaneous coronary intervention complications and guide catheter size: bigger is not better. JACC Cardiovasc Interv. 2009;2:636–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Halpern EJ, Levin DC. Normal coronary anatomy. In: Halpern EJ, editor. Clinical cardiac CT: anatomy and function. New York: Thieme; 2008. p. 35.Google Scholar
  13. 13.
    Hiwatashi A, Iwabuchi M, Yokoi H, Tayama S, Sakamoto T, Noda K, Shibata Y, Hikichi Y, Node K, Ueno T, Nobuyoshi M. PCI using a 4-Fr “child” guide catheter in a “mother” guide catheter: Kyushu KIWAMI(R) ST registry. Catheter Cardiovasc Interv. 2010;76:919–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the ACCESS study. J Am Coll Cardiol. 1997;29:1269–75.CrossRefPubMedGoogle Scholar
  16. 16.
    Kumar S, Gorog DA, Secco GG, Di MC, Kukreja N. The Guideliner “child” catheter for percutaneous coronary intervention—early clinical experience. J Invasive Cardiol. 2010;22:495–8.PubMedGoogle Scholar
  17. 17.
    Mamas M, D’Souza S, Hendry C, Ali R, Iles-Smith H, Palmer K, El-Omar M, Fath-Ordoubadi F, Neyses L, Fraser DG. Use of the sheathless guide catheter during routine transradial percutaneous coronary intervention: a feasibility study. Catheter Cardiovasc Interv. 2010;75:596–602.PubMedGoogle Scholar
  18. 18.
    Mizuno S, Takeshita S, Taketani Y, Saito S. Percutaneous coronary intervention using a virtual 3-Fr guiding catheter. Catheter Cardiovasc Interv. 2010;75:983–8.PubMedGoogle Scholar
  19. 19.
    Pritchard CL, Mudd JG, Barner HB. Coronary ostial stenosis. Circulation. 1975;52:46–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Takahashi S, Saito S, Tanaka S, Miyashita Y, Shiono T, Arai F, Domae H, Satake S, Itoh T. New method to increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv. 2004;63:452–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Yildiz A, Okcun B, Peker T, Arslan C, Olcay A, Bulent VM. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol. 2010;33:E60–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Yip HK, Wu CJ, Yeh KH, Hang CL, Fang CY, Hsieh KY, Fu M. Unusual complication of retrograde dissection to the coronary sinus of valsalva during percutaneous revascularization: a single-center experience and literature review. Chest. 2001;119:493–501.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dushen Tharmaratnam
    • 1
    Email author
  • Martin T. Rothman
    • 1
    • 2
  • Ajay Jain
    • 1
  1. 1.Department of CardiologyBarts and the London NHS Trust, London Chest HospitalLondonUK
  2. 2.Medtronic IncLos AngelesUSA

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