Sheath, Guidewire and Catheters

Diagnostik Invasif & Intervensi Non Bedah

Pusat Jantung Nasional Harapan Kita Jakarta

Heroe Moestiko
 Type of sheaths (a tubular case)
Standard sheath (10cm/12cm)
Long sheath (16cm/23cm/25cm)
Arrow sheath (12cm/24/cm/35cm.45cm/65cm)
Shuttle sheath (90cm)
Balkin sheath (40cm)
Mullins sheath (63cm)
Type of sheaths (a tubular case)
& indications
 Type of sheaths (a tubular case)
& indications
STANDARD SHEATH

Normal
Vessel
anatomy

ARROW SHEATH

Tortuous vessel
 Type of sheaths (a tubular case)
& indications SHUTTLE SHEATH (90cm)
ARROW SHEATH
 Commonly use for tortuous artery
 To allow the catheter to go up
easily but sometimes in very
tortuous Aorta an extra stiff wire
is needed
 Mainly use in PTA Carotid artery
 Also use in peripheral interventional,
usually PTA Subclavian
 Type of sheaths (a tubular case)
& indications MULLINS SHEATH
BALKINS SHEATH

 Mainly use in pediatric interventional

 Interventional Peripheral Sheath
 Also use in peripheral interventional,
 Cross-over sheath (contra-lateral)
usually PTA Subclavian
 For PTA iliac, SFA and etc
 Support for very tortuous Aorta.
FEMORAL SHEATH
Sheath
Dilator
Wire 0.038”
TYPES OF RADIAL SHEATH

RADIAL SHEATH 6F TERUMO

•Sheath + dilator
•Blade
•Angiocath 20G
•Terumo wire 0.025”

RADIAL SHEATH 6F AVANTI (CORDIS)

•Sheath + dilator
•Punture needle 21G
•Wire 0.021”
 VARIOUS SIZES OF SHEATH
 COLOUR CODING:
 4F- RED 9F- BLACK
 5F- GREY 10F- PURPLE
 6F- GREEN 11F- YELLOW
 7F- ORANGE 12F- DARK BLUE
 8F- BLUE 13F- DARK GREEN
14F- PINK
ANGIOGRAPHIC/GUIDING
CATHETERS
Catheter Structure
HOW CATHETERS ENGAGE
AND SIT IN THE AORTA
Catheter Engagement

NOT COAXIAL
ENGAGEMENT

COAXIAL
ENGAGEMENT
 ANGIOGRAPHIC CATHETERS
 Use for diagnostic purpose
only
 Small ID which not allows
interventional devices such
as balloon, stent, IVUS and
etc to enter

Pigtail
DIAGNOSTIC CATHETER
( FEMORAL)

JL JR
DIAGNOSTIC CATHETER ( RADIAL )

OPTITORQUE 5F
GUIDING CATHETER
 Use for interventional
purposes
 Has larger ID to allow
coronary devices such as
balloon, stent, IVUS,
export catheter to enter
CATHETERS & NATIVE
ARTERIES
LCA:
 Judkins Left
 Amplatz Left
 Castillo
 Optitorque
 Extra Back-up (XB)
RCA
 Judkins Right
 Amplatz Right/Left
 Multipurpose 1
 Castillo
 Optitorque
 Extra Curve Right(ECR)
 Hockey Stick
CATHETERS & GRAFT
IMA to LAD:
 Internal Mammary Artery
 Judkins Right

SVG to LCA
 Judkins Right
 Amplatz Left
 Left Coronary Bypass

SVG to RCA
 Multipurpose
 Judkins Right
 Left Coronary Bypass
 VARIOUS CURVES OF
CATHETERS
JUDKINS RIGHT 3.5 Multipurpose 1
JR 6
(MPA1)

JR 4 Amplatz Right 1 (ARMOD1)

MPB1

JR 5 Amplatz Right Moderate

(ARMOD)

AR2
 VARIOUS SHAPE OF
CATHETERS
JUDKINS LEFT 4

Amplatz Left 1 Left Coronary

Bypass -LCB

JL5

AL 2
RCB

JL 6

Internal Mammary
AL 3 Artery - IMA
 VARIOUS SHAPE OF
CATHETERS

OPTITORQUE
145º Pigtail
Straight Pigtail
Peripheral Wires
Diameter 0.035’ – 0.038’
J-shaped tip: digunakan untuk arteri radial dan femoral
Panjang wire 140 – 180 cm
Cont..
Standard wire
Straight tip wire
Stiff of superstiff wires
Exchange wire
Hydrophilic wire ( Terumo )
Coronary Wires
Untuk melewati stenosis atau oklusi di arteri koroner
Diameter 0.014’
Terbuat dari stainless steel atau nitinol
Panjang 190cm
 TUJUAN
• Untuk mencapai ujung dari pembuluh darah
• Sebagai rel untuk memasukan alat ke
pembuluh koroner
• Untuk mengakses lesi
• Untuk melewati lesi tanpa adanya trauma
• Untuk memberikan support saat
memasukan alat intervensi
Coronary guidewire
Coating
HYDROPHILIC
• Respon terhadap air
• Dipasang diatas polymer
atau stainless
steel( termasuk tip coils)
• Tipis,tidak licin saat kering,
butuh pelumas
• Menjadi gel saat basah
• Meminimalkan gesekan
• Meningkatkan kemampuan
untuk menyusur
• HYDROPHOBIC
• Menolak air
• Dilapisi silikon disepanjang
wire kecuali pada tip
• Harus basah
• Meminimalkan gesekan
• Meningkatan kemampuan
untuk menyusur
• Platinum di tip radio opaque
( biasanya 3-25cm)
3 Komponen Wire Coronary

Coating

Core

Coil
 STRUCTURE

 CORE-Material
Diameter
Core taper
 TIP
 COILS, COVERS & COATINGS
Hydrophilic = gel-like when wet

Slide through vessels + lesions

Hydrophobic = wax-like when wet

Provides tactile feedback

 Polymer Jacket = gel-like & smooth
(Lubricious)

Tracks / slides through tortuous vessels and

heavily calcified lesions.
Tip Load
Tapered Wires

Fielder XT, XTA, FC

Pilot 50, 100, 200

TERIMA KASIH