Abstract
The use of microcatheters as a coronary interventional tool for a therapeutic approach to complex coronary interventions like bifurcation lesions, ostial location, tortuous anatomy, angled takeoffs, coronary calcification, and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is growing among cardiologists across the country. During the treatment of such complex lesions, microcatheters play an essential part of the tool kit with both single-lumen and double-lumen microcatheters (DLMs) having their specific niche areas. The selection of microcatheters involves a detailed understanding of the microcatheter specification, lesion anatomy, lesion location, vessel tortuosity and trajectory, and crossing techniques. The selection of appropriate crossing techniques with different microcatheters increases success rates of PCI, reduces procedural time and contrast use, and lowers the radiation. However, the use of microcatheters and their technicalities have not yet fully realized by many operators and their true scope has not been fully explored. This article discusses and summarizes the thoughts and key opinions of experts in this field.
Highlights
Coronary lesions often exhibit certain features posed as challenging while performing a percutaneous coronary intervention (PCI) viz. thrombus, bifurcation, ostial lesion, calcification, and chronic total occlusions (CTOs) [1]
Understanding the significance of a microcatheter in the cardiac catheterization lab—which included a discussion on the types of microcatheter available in the Indian market and their significance in PCI procedures
Interventional cardiologists use various lesion crossing strategies for PCI procedures coupled with microcatheters for optimal guidewire manipulations through the complex coronary anatomy
Summary
Coronary lesions often exhibit certain features posed as challenging while performing a percutaneous coronary intervention (PCI) viz. thrombus, bifurcation, ostial lesion, calcification, and chronic total occlusions (CTOs) [1]. Single-lumen microcatheters (SLMs) are standard microcatheters intended to provide support to enable the placement of guidewires in a vessel. They are simple to handle and allow wire reshaping or wire exchange without losing the vessel entry. They improve the guidewire penetration ability and could prevent wire tip prolapse/plop (Figure 1) These microcatheters can be maneuvered through a tortuous arterial segment proximal to a lesion by providing extra support to a guidewire. They can be used to visualize a distal vessel by injecting a contrast medium [2]. Other microcatheters like MambaFlex R (Boston Scientific, Massachusetts, USA), Teleport R (Cardiovascular Systems, Inc., Minnesota, USA), and Microcross R (Roxwood Medical, Inc., California, USA) have not got approval in India at present
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