ABSTRACT
Selection of an appropriate guiding catheter is fundamental to the success of every coronary interventional procedure. The catheter should provide coaxial access to the coronary artery to facilitate passage of a guide-wire, stability for delivery of balloons and bulky devices, and sufficient contrast flow to adequately visualize the coronary anatomy. A progressive decrease in the bulk of devices, an increase in their flexibility, and technical improvements in guiding catheter design have permitted a gradual reduction in guiding catheter caliber. Guiding catheters are typically constructed with three individual layers: outer polyurethane or polyethylene layer, middle wire braid layer and inner layer. Hybrid techniques to enhance guide catheter support involve the use of coronary wires and balloons to stabilize the system. Saphenous vein grafts (SVGs) to the right coronary artery (RCA) are best approached with a multipurpose catheter if the takeoff is vertical, or a right Judkins or right coronary bypass (RCB) catheter if it is more horizontal.
