30.

4
Microcatheters
μικρός=small + καθετήρας=catheter

Emmanouil S. Brilakis, MD, PhD

 PCI: the steps
1. Planning
2. Monitoring
3. Pharmacology
4. Access
5. Engagement
6. Angiography
7. Determine target lesion
8. Wiring
9. Lesion preparation
10. Stenting
11. Closure
12. Physiology
13. Imaging
14. Hemodynamic support
 Microcatheter
classification

Vemmou E. et al. Expert Rev Med Devices 2019

 PCI: the process
1. Sheath

Physiology

Imaging
3. Guide
2. Guide 4. Microcatheter Guidewire
extension
Balloons

Stents

Matryoshka doll
 Microcatheter vs. Over-The-Wire Balloon
OTW balloon Microcatheter
Balloon

Shaft marker
Flexibility + +++

Marker at tip No Yes

Cost Less More

Resistance to kinking + +++

A. Big microcatheters B. Small microcatheters C. Angulated microcatheters

Antegrade CTO crossing Advance through tortuosity Access side branches

D. Dual lumen microcatheters E. Plaque modification microcatheters

Modify lesion
Parallel wiring
Access side branches
 Microcatheter functions
1. Support guidewire
2. Allow reshaping of guidewire tip
3. Facilitate guidewire exchanges
4. Protect proximal vessel from guidewire injuries
5. Inject contrast or medications
6. Delive coils/fat in case of perforation
Impact of microcatheter on guidewire tip stiffness

Waksman, Saito. Chronic total occlusions: a guide to revascularization. Wiley-Blackwell; 2013.

 7 Global Principles for CTO PCI
1. Principal indication: to improve symptoms
2. Dual angiography + careful angiographic review
3. Use of microcatheter for guidewire support
4. 4 CTO crossing strategies: AWE, ADR, RWE,
RDR
5. Change increases likelihood of success
6. CTO PCI should be done at experienced-well
equipped centers
7. Stent deployment should be optimized
101 operators - 50 countries – Circulation 2019
 Microcatheters 1: big
①0.86mm 　 (2.6Fr)
②0.82mm 　 (2.5Fr) ③0.86mm 　 (2.6Fr)
Marker coil

Corsair Pro

Turnpike

Mamba

Teleport
 Turnpike shaft construction

Multi-layer shaft provides combination of flexibility and torque

response
Braid:
For tensile strength

PTFE liner: Dual-layer, bidirectional coil:

Facilitates smooth Adds kink-resistance & torque
guidewire movement (single coil in distal 21 cm of LP shaft)
 Turnpike
• Clockwise Rotation – Coil Interaction

Coil Expansion

Coil Contraction

Simultaneous contraction of outer coil and expansion of inner coil creates

a gear-like mechanism to transmit torque from hub-to-tip
 Microcatheters 2: small

Caravel

FineCross

Turnpike LP

Corsair XS

MicroCross 155 cm
45-year-old man with ESRD & severe angina
Transit +
Whisper
 Microcatheters 3: angulated

Venture Swift Ninja SuperCross

 Venture (Vascular Solutions)

McNulty et al. CCI 2005 - Iturbe et al. CCI 2010

Courtesy: William Nicholson, MD
Courtesy: William Nicholson, MD
Microcatheters 4: dual lumen
4 mm

ASAHI Sasuke
5 mm

Kaneka Crusade
5 mm

IMDS NHancer
20 mm

Teleflex Twin-Pass
Parallel wiring with dual lumen microcatheter
 ReCross

A.

B. C.

D.
Dual-lumen microcatheter functions
Non-CTO PCI
1. Insert 2nd guidewire
2. Wire side branch of bifurcation
3. Reversed guidewire technique
CTO PCI
4. Parallel wiring
5. Wire CTOs with SB next to proximal cap
6. Guide in SB at distal cap
7. Wire septal branches
8. Antegrade wiring over externalized wire
Difficulty
rewiring
Twin Pass
Microcatheters 5: Plaque modification
 Microcatheter complications
1. Deformation, entrapment
• If fatigue – exchange microcatheter
2. Tip fracture
3. Interlocking with other equipment over same
wire
4. Damage from atherectomy
 Microcatheter complications
1. Deformation, entrapment

Courtesy: Dr. William Nicholson

Microcatheter deformation
 Case 1
RCA CTO
Dual injection
Wire out
 Tornus
twisted
Parallel wire
Final
 Lessons

1. Do not turn
microcatheters
without guidewire
inside
2. Avoid microcatheter
over-rotation
3. Equipment
entrapment: surgical
removal may be
required
 Microcatheter complications
1. Deformation, entrapment
• If fatigue – exchange microcatheter
2. Tip fracture

Courtesy Dr. William Nicholson

 Microcatheter complications
1. Deformation, entrapment
• If fatigue – exchange microcatheter
2. Tip fracture
3. Interlocking with other equipment over same
wire
4. Damage from atherectomy
• Examining the Finecross MC immediately
post-procedure, a pinhole is noted
 • Microscopic Analysis of Finecross MC

Finecross location during

treatment. Pinhole (0cm on
scale) appears to be in or close
to tip of guide catheter

Spun area, light scuffing, no apparent material loss

Finecross non spun
area, control
 • Microscopic Analysis of Finecross MC

Multiple spun areas, light scuffing. No to very limited material lost, but braid
may be exposed. (disinfection process damages polymer, no pre-images)

Pin hole identified 48mm from distal tip.

Area appears to be ablated with material removed.
 Microcatheter
classification

Vemmou E. et al. Expert Rev Med Devices 2019