Instrumentation: Working Chain
The catheterization of coronary arteries for diagnostic or therapeutic reasons is accomplished by establishing a working chain of several consecutive and related steps, all of which can be hampered by technical difficulties. This working chain stretches from establishing the access site up to navigation of the coronary target site, all of which can become a source of problems. This chapter presents scenarios that are frequently encountered by interventional cardiologists in clinical practice, as well as techniques to overcome such challenging situations. Issues related to radial access, poor guidewire support, and access to difficult side branches are also covered. Moreover, owing to the increasingly complex nature of intracoronary interventions, combined use of devices is common. Therefore, pros and cons of smaller versus larger guiding catheters, the diameters of commonly used intravascular devices, and their compatibility are discussed and presented in tables. In addition, figures illustrating the mechanics of backup forces acting on catheters, common anatomic variations, and the integrated use of intracoronary devices for delivering devices are reviewed.
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