Fundamentals of coronary interventional equipment

Author(s): Jeffrey Cook

Interventional cardiology is an increasingly complex field, with new techniques and corresponding advances in equipment occurring annually. Keeping abreast of the expansive number of tools available can be daunting. A fundamental knowledge regarding the basic equipment that is employed in routine Percutaneous Coronary Intervention (PCI) cases is important for practitioners of interventional cardiology, as well as candidates for the interventional cardiology boards exams. Guide catheters share function with diagnostic coronary catheters, with many additional design features to facilitate smooth delivery of interventional devices. Appropriate choice of the guide catheter in a coronary case can be accomplished with attention to details of the diagnostic angiogram and fitment of the diagnostic catheter. Coronary guidewires are used to cross the coronary lesion, deliver devices, and, at times, navigate highly complex coronary anatomy. Guidewires are available with specialized characteristics altering cross-ability, track-ability, and device deliverability. Angioplasty balloons are also variable in design, and the choice of balloon often involves compromise of deliverability, lesion cross-ability, and compliance. In contemporary PCI practice, balloons are commonly used to pre and post-dilate lesions to be stented, as well as to deploy the stent itself. In this review, we examine guide catheters, coronary guidewires, and angioplasty balloons; as well as the basic evidence-based approach in PCI case. Appropriate choice and utilization of PCI equipment will improve procedural efficiency and safety. Awareness of the capabilities and, just as importantly, the limitations of our equipment will help us to improve patient care and outcomes on a day-to-day basis.