ABSTRACT
GUIDING CATHETERS Introduction 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 guidewire, stability for delivery of balloons and bulky devices, and sufficient contrast flow to adequately visualize the coronary anatomy. It should have a soft atraumatic tip to minimize the risk of injury to the coronary ostium. Changes in procedural complexity over the past two decades have had important influences in guide catheter selection. Bulky inflexible devices such as the directional atherectomy catheter and early generation coronary stents required considerable support from the guide and gentle deflectable curves distally. 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. Whereas only 59% of guiding catheters were 6 Fr in 2000, the estimated distribution of catheter diameters in the United States market in 2007 was 79% 6 Fr, 14% 7 Fr, and 7% 8 Fr [Boston Scientific (BSC), Natick, Massachusetts, U.S.]. The approximate inner diameter of contemporary 6 Fr guiding catheters is 0.07 in., compared with 0.08 in. for 7 Fr guides and 0.09 in. for 8 Fr guides.
