Transcript Slide 1

Peripheral angioplasty
Overview, Hardware
Frijo Jose A
Vascular Access
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Relatively disease-free, without signi Ca
Over a bony structure, if possible
Angle of entry- 30⁰-45⁰
If access vessel-small/potentially diseasedmicropuncture tech preferred
Vascular Access sites
Retrograde Common Femoral Artery Access
•Common access site used for peripheral
diagnostic angiography and intervention
•Prevent injury to the less diseased
extremity
Vascular access sites
•Contralateral femoral retrograde access :
•Internal iliac stenoses are best treated
from a contralateral approach
•SFA,PFA- lesions located within the
CFA/involve SFA/PFA ostium •Proximity to arterial puncture site,
Bifurcation anatomy of CFA
•Also allows treatment B/L disease with a
single arterial puncture
Vascular Access site
Antegrade Common Femoral Artery Access:
•Required for infrainguinal proced
•Approx 3cm CFA lies betw
ligament & FA bifurcation
•Inorder to access CFA, skin entryprox to ing ligm
•Access too close to F bifurc –
inadeq working room to selectively
cath SFA
Vascular access sites
Ipsilateral popliteal retrograde access:
•Useful in SFA occlusion with failure to cross
from contralateral or antegrade
•Ostial SFA/CFA lesions may also be approached
via PA in acute angled terminal ao bifurc
•CI- aneurysms of PA, pathology of popliteal
fossa- Baker’s cyst
Brachial Artery Access
• Pref access for visc arterial [CA, SMA] interventions
• PC approach at BA can lead to a ↑compli rate
– UL arts – smaller, prone to spasm
– A small hematoma- Could lead to brachial plexopathy
• Itv req >6F sheaths/smaller pt→open approach
preferred
• Left BA access pref over Rt- can avoid carotid origin
• A micropuncture tech should be used for all PC BA
intervention
Wire selection
• Many-Teflon/silicone :Some- hydrophilic
• Hydr-stenosd/torturous+angle tip–Glidewire
– Can be used for crossing tight lesions and can be
advanced independent of a guidewire
• 014,018,025,035,038-for initial access,
038:18g needle, 018:21g needle
Estimated distances from FA access
GuidewireLesion
Interaction
• Floppy portion moving in a linear
• Floppy portion piles up prox to lesion—no chance
to cross- backup,redirect,if straight tip→steerable
• Floppy tip bent with min R—Cautiously adv wireonce crossed, wire should straighten- advancing
a “buckledup” wire- force→embolization
• Floppy tip “buckledup” with R—
backup,redirect,adv -dissect,embolz,wire damag
Catheter ( diagnostic/ guiding)
Length depends on location for using
a) abdominal aorta = 60 to 80 cm length
b) BTK,carotid or subclavian areas 100 to 125cm length
Polyethylene- ↓coef friction, pliable
Polyurethane- softer, even ↑pliable→ tracks wires better
Nylon- stiffer, can tolerate ↑flow rate- amenable to angio
Teflon- stiffest- used mainly for dilators & sheaths
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4F IMPRESS Simmons 1 Catheter 65cm..038
Side Ports:N/A
Catheter Shape:SIMMONS 1
French Size:4
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5F IMPRESS Simmons 2 Catheter 65cm..038
Side Ports:N/A
Catheter Shape:SIMMONS 2
French Size: 5
SOS Omni selective catheter
• Soft, atraumatic, Super-radiopaque tip
• Reforming in desc thoracic aorta – below great
vessels rather than transverse arch –safety
• The catheter should be pulled from the desc ao
into abd ao with a floppy guidewire “leading,”
sometimes with a rotating motion
• The soft, flexible atraumatic tip can be placed
deeper into the artery (>1 cm), ↓chance of
“catheter kickout.”
• The shaped tip allows the guidewire to flick into
the origin of the RA
Omni Flush Angiographic Catheter
• Designed as a single catheter to perform flush
aortography, B/L“run off” studies of lower
extremities and to cross ao bifurcation with ease
for C/L diagnostics in interventional procedures.
• Super-Radiopaque tip
• Reforms and maintains shape—even under
injection pressure—with less catheter whipping,
resulting in less vessel wall injury
• Less contrast reflux than other flush catheters,
thus resulting in lower total contrast dose
Accesses and Selective Guiding Catheters
for Some Basic Interventions
Carotid Artery
1.First choice access—either FA
2.Alternative access—left BA
3.Selective catheter—
Right carotid: H1,Simmons,Vick;
Left carotid : angled glidecath,H1,Simmons
Subclavian Artery
1.First choice—either FA
2.Alternative access—ipsilateral BA
3.Selective catheter– angled Glidecath,H1,Simmons,H3
Celiac or SMA
1.First choice—either FA
2.Alternative access—left BA
3.Selective catheter—RIM,Chuang-C,Chuang-3
Renal Artery
1.First choice—contralateral FA
2.Alternative access—left BA
3.Selective catheter—C2,RDC,Sos-omni
Infrarenal Aorta
1.First choice —either FA
2.Alternative access—left BA
3.Selective catheter—omni-flush,RIM,C2
Superior Femoral Artery
1.First choice—contralateral FA
2.Alternative—ipsi retro FA for run-off; ipsi antegrade for interv
3.Selective catheter—Berenstein,Kumpe,Vertebral
Tibial Arteries
1.First choice—contralateral FA
2.Alternative—ipsi retro FA for run-off; ipsi antegrade for interv
3.Selective catheter—Kumpe,Vertebral
Kumpe catheter
Guiding Catheter vs Sheath
• The use of a guide or sheath is determined by operator bias
• Sheaths are designed with a simple diaphragm or a
hemostatic valve, guiding catheters always require hemostatic
valves be attached
• During intervention, the guide catheter or sheath should be
placed near the lesion to provide for better visualization and
improved support
Balloons
• In selecting a balloon, the following criteria should be considered:
a) Guidewire ( 0.014“, 0.018“, 0.035“)
b) over the wire (OTW) or monorail system
c) shaft length
• 0.014“ balloon system is usually for carotid, vertebral, renal,
infrapopliteal arteries
• 0.035“ balloon system for subclavian, innominate, aortoiliac,
superficial femoral artery
• 0.018“ balloon system also in SFA, infrapopliteal, depends on
what the operator prefers
Law of Laplace
• Circumfer force/tension (T) exerted on wall of
an inflatd balln ~P within balln & R (T=P×R)
• Balln twice R of a smaller balln- twice wall T
for given inflation P→D kept constant, T on
wall of balln will ↑linearly with ↑inflatn P
• Larger ballns -require ↓P than smaller
ballns to generate substantial dilating forces
• Larger vessels (Ao) require ↓P to dilate &
rupture
• Balloon cath with a D matchng outflow vessel
beyond lesion
• Balloon length should be > lesion
• Balloon centered on lesion & inflated slowly
• Inflation maintained for 20s- deflatedreinflated 3 inflations of 20s
Subintimal angioplasty
• Hydrophilic wire not passng
• Carefully adv into subintimal plane- if not
spontaneously, gentle inflation of balloon at
edge of the plaque
• Wire traversed the lesion subintimaliy
• Hydrophilic catheter or other re-entry device
passed OTW to guide it back into lumen
• Standard angioplasty of subintimal plane
performed, with stent placement
Femoropopliteal Artery Intervention
Subintimal angioplasty
Stents
• The types of stent used in peripheral interventions:
a) Balloon-expandable
b) Self-expandable
c) Stent graft
Balloon-expandable stents
• Require positive pressure for expansion
• Typically rigid with high radial force
• Size of the balloon-expandable stent equals to
the size of the reference vessel diameter
• Ideal for immobile parts of the body-ie,
subclavian, renal, mesenteric, iliac arteries and
at ostial locations
Self-expandable Stents
• Deployed in vessels that are flexible or twist during
movement of neck, shoulder or leg
– carotid, axillary, superficial femoral artery, popliteal artery
• Nitinol - best flexibility and memory
• Stent compressed over a delivery cath & covered
with sheath
• Stent deployment achieved by pulling back the
sheath
• Stent diameter should be 1-2mm > ref vessel D→
adeq stent apposition
Self-expandable Stents
• Some degree of foreshortening- to be taken into
account when choosing
• More difficult to place with absolute precision
• Generally comes in longer length than BES
• Their ability to continually expand after delivery
allows them to accommodate adjacent vessels of
different size
Stents
Demonstrating the Nitinol self-expandable stent deployment
Stent Grafts
• Used to exclude aneurysm, treat perforations when
prolonged balloon inflation failed
• Wallgraft and Viabahn are two options
Decision between SE or BE stents in Iliac Lesions
• Balloon expandable
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Aortoiliac bifurcation
Common iliac
Calcified lesions
Chronic occlusions (?)
• Self expanding
– Vessels flexible/twist
during movement
– Tortuous vessels
– Distal external iliac
artery
– Contralateral approach
– Long diffuse lesions
– Aortoiliac bifurcation
(long lesions)
Technique
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Retrograde Iliac stent placement
Techniques
Cross-over technique
• A patient’s complaint of low back pain during
balloon inflation may be a warning sign of
adventitial stretch, which may occur before
aortic rupture
Femoropopliteal Artery Intervention
• Balloon size & length matched to the size ( ~5-6mm)
& lesion length( ~40- 300mm) of SFA
• ↑ angiographic results may be accomplished with
prolonged inflation times ( 3-5 minutes)
• Dissections are commonly seen after balloon dilation
( due to heavy calcification)
Femoropopliteal Artery Intervention
Stentimplantion ( always SX-Stents):
• Sizing the SX- stent ~ 1mm > SFA
• Postdilation with 5.0-6.0 mm diameter balloon
• Popliteal artery -> avoid stent = high risk of stent
compression or fracture
Infrapopliteal Interv
• Knee-to-foot patency of one of the three
branches is usually sufficient to prevent critical
lower-limb ischemia
• Claudication is rarely the result of isolated disease
of the infrapopliteal arteries
• Re-stenosis after intervention in these vessels is
typically the highest among the lower limb sites
• Obstructive disease in these arteries is often
occlusive, diffuse and complicated by heavy
calcific deposits
Infrapopliteal Interv- wire selection
• Only atraumatic 0.014“ / 0.018“ guide wires
should be used-0.014“ prefered due to vessel
diameter
• Type selection ( floppy, medium,stiff) will be
driven by the type of disease
Infrapopliteal -Balloon Angioplasty
• Low profile balloon with high pushability and
trackability to easy cross the lesion
• Flexibility in small collateral branches
• 0.014”/ 0.018" wire compatibility
• Diameter 1.5mm-4.0mm
• Long (20-210 mm) to reduce procedure times
and dissection
Infrapopliteal- Balloon Angioplasty
Long balloons (210mm/ tapered)
•Reduced risk of dissections
( no balloon overlap)
•Total intervention /revascularization
time significantly shorter
•Reduced X-ray dose for patients, operators
as well as for the assistants
Renal artery stenosis
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Usually occurs in the proximal 2 cm
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~75% of lesions are caused by atherosclerosis
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Lesions can be single or multiple, unilateral or
bilateral (~25%)
• Diameter: 6.0-6.5mm for men
5.5-6.0mm for women
• Length 3-7 cm
Renal artery-Equipment
Diagnostic
Intervention
• Wires
• Wires
– 0.035” for catheter
placement
• Diagnostic catheter
– 0.014”
– 0.035” for catheter
placement
• Guiding Sheath
• Guide Catheter
• Balloons ( 0.014”
compatible)
– Low profile
– Undersized for predilation
• BE-Stents
Reanal artery stenting
1. Catheter or sheath placement
2. Guide wire (0.014“) insertion. Rosen wire has
soft curled end- ideal- prevents perforating
small renal branch vessels
3.Stent placement -> as soon as the tip reach the
lesion GC is pulled back into the Aorta
4.Stent deployment, proximal struts should
protrude 1-2mm into the aorta
5. Flaring the ostium of the stent ( optional),
opens the way for re-intervention and covers
the plaque in the aorta
Subclavian PTA
• Femoral access used except for TO/severely
angulated – BA preferred
• LSCA – FA- direct take-off : RSCA because of its
angulated take-off from inno A- ipsi BA
• Ostial RSCA, FA can protect the right CCA
• Total occlusions- combined approach
• Usually pre-dilated with a slightly undersized balloon
• BES sized 1:1 with ref D
• Ao-ostial lesions - stent protrude (1–2mm) into Ao
• BES - Ao-ostial locations
• SES- long segment/more flexibility needed/lesions
beyond IMA→external compression
• COOK
Catheters
• Slip-Cath Beacon Tip Catheters
• Beacon Tip Torcon NB Advantage Caths
• Torcon NB Advantage Catheters
• CXI Support Catheters
• Beacon Tip Royal Flush Plus High-Flow
Catheters
• Royal Flush II Nylon Catheters
Slip-Cath Beacon Tip Catheters
• Hydrophilic Coating
• Enhanced radiopaque Beacon tip
• Sixteen stainless steel wire braid imparts 1:1
torque control to catheter tip & ↑pushability
• Nylon material resists softening during
prolonged catheter manipulation
Slip-Cath Beacon Tip Catheters
Beacon Tip Torcon NB Advantage Caths
• Enhanced radiopaque Beacon tip
• Gradual transition of radiopaque Beacon tip to
catheter shaft
• Sixteen stainless steel wire braid
• Nylon material
Torcon NB Advantage Catheters
• Sixteen stainless steel wire braid
• Nylon material
• Short, flexible atraumatic catheter tip
• Beacon Tip Royal Flush Plus High-Flow
Catheters
• Royal Flush II Nylon Catheters
CXI Support Catheters
• For use in small vessel/superselective anatomy
for diagn & interv procedures, incl peripheral use
• Low profile from tip to hub ensures smooth
transition through small vessels
• Shaft's polymer material offers desired flexibility
• Braided SS entire length -pushability
• Hydrophilic coating
• Embedded radiopaque markers -size the vessel
segment length
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ATB ADVANCE PTA Dilatation Catheter
Advance 14LP
Advance 18LP
Advance 35LP
ATB ADVANCE PTA Dilatation Catheter
• Designed for iliac, renal, popliteal,
infrapopliteal, femoral and iliofemoral
• Also intended for postdilatation of balloonexpandable peripheral vascular stents
• 40,80,120
Advance 14LP
• Low Profile
• Provides the trackability and pushability to reach
even the most remote infrapopliteal lesions
• Hydrophilic coating on balloon and distal shaft,
along with a smooth tip transition
• Maintains super-low profile after inflation
• 4 Fr sheath compatibility for all sizes
• 20 to 200 mm in 2, 2.5, 3, 4 mm D
• 170
Advance 18LP
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Low Profile PTA Balloon Dilatation Catheters
Super-flexible tip
Advanced rewrap technology
80,135
Advance 35LP
• first 8 mm x 8 cm 5 Fr sheath
• Low-profile design tightly tapers to the wire
• Double-lumen D-shaped design allows rapid
inflate/deflate
• 80,135
Amplatz Stiff Wire Guides
• The wire guide has a stiff shaft and a gradual
transition to a very flexible distal tip
– TFE Coated Stainless Steel-035,038: 145,180,260straight
– TFE Coated Stainless Steel with Heparin Coating035: 145,180,260-straight
• 8cm-flexi tip
Amplatz Extra-Stiff Wire Guides
• The increased inner diameter of the wire
guide coil allows utilization of an extra-stiff
mandril while maintaining tip flexibility.
– TFE Coated Stainless Steel-025,035,038:
80,145,180,260-straight & curved: 300-straight
– TFE Coated Stainless Steel with Heparin Coating035: 80,145,180,260-straight & curved
Amplatz Ultra-Stiff Wire Guides
• The increased inner diameter of the wire
guide coil allows utilization of an ultra-stiff
mandril while maintaining tip flexibility.
– TFE Coated Stainless Steel-035,038: 80,145,180straight
– TFE Coated Stainless Steel with Heparin Coating035: 145,180-straight
• 8cm-flexi tip
Roadrunner Extra-Support Wire
• Complex diagnostic/interventions where extra
support needed for cath exchange/manipulation
of devices
• Heavy-duty nitinol alloy mandril provides support
while imparting 1:1 torque response to distal
platinum spring coil tip
• Angled tip facilitates directional control
• Lubricious TFE coating -low coefficient of friction
• 014,018
• 180,270,300
Cope Mandril Wire Guides I
• Stainless Steel
• Platinum coil ↑visualization and an angled
floppy tip for precise directional control
• 018
• 40,60,100,125
• Standard taper-7cm coil
Cope Mandril Wire Guides II
• Nitinol mandril kink resistant and provides 1:1
torque control
• Platinum coil ↑visualization and an angled
floppy tip for precise directional control
• 018
• 60,100,125
• Standard taper-7cm coil, short taper-7cm coil
Rosen Curved Wire Guides
• The heavy-duty mandril, 2 cm flexible tip and
tightened “J” configuration
• TFE Coated Stainless Steel-035:
80,145,180,220,260
• TFE Coated Stainless Steel with Heparin
Coating-035: 145,180,260
The Graduate Measuring Wire Guides
• Used to determine accurate sizing of vessel
lumen prior
• Gold radiopaque markers delineate 25 cm in
length for precise measuring accuracy.
• Six distal markers are spaced 1 cm apart.
• Four proximal markers are spaced at
5 cm increments.
• 035
• 145,180
Reuter Tip Deflecting Wire Guide
• Used with Reuter Tip Deflecting Handle for
curving or deflecting catheter tips during
selective and superselective angiography
• Facilitates catheter tip movement by
controlling the deflection of the wire guide tip
within catheter lumen
• Distal tip of wire guide must never extend
beyond tip
Double Flexible Tipped Wire Guides
• Permits alternative use of both ends of wire
guide, depending on procedural needs
Zilver 518
• Vascular Self-Expanding nitinol Stent- iliac
arteries
• Recomm 5.0 Fr sheath/7.0 Fr guiding cath
• Accepts .018 inch wire
Zilver 518 RX
• Vascular Self-Expanding Nitinol Stent – Rapid
Exchange-iliac
• Recommended 5.0 Fr sheath/7.0 Fr guiding
catheter
• Accepts .018 inch diameter wire guide.
Zilver 635
• Vascular Self-Expanding Nitinol Stent
• Recommended 6.0 Fr sheath/8.0 Fr guiding
catheter size
• Accepts .035 inch diameter wire guide
• TERUMO
• Guiding Sheaths (5-8 Fr)
Pinnacle Destination
• 5-8 F
• 45,65,90
• Hydrophilic coating
• All dilators are 0.038" wire compatible
glidewire
Peripheral Guidewires
(0.032"-0.038")
Standard Glidewire
Shapeable Tip Glidewire
Long Taper Glidewire
Stiff Shaft Glidewire
Stiff Shaft Long Taper Glidewire
1 cm Taper Glidewire
J-Tip Glidewire
Bolia Curve Glidewire
Glidewire Advantage™
Small Vessel Guidewires
(0.018"-0.025")
Glidewire Standard and Shapeable Tip
Glidewire GT Super-Selective
Glidewire Gold
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Hydrophilic Coated Catheters
Glidecath (4 Fr)-65,100,120-038
Glidecath XP (5 Fr)-65,100-038 (↑flow rate)
Glidecath (5 Fr)-65,100-038
• Microcatheters
• Progreat™ (2.4 Fr, 2.7 Fr)- 110/130OD:0.97/0.9=2.9/2.7 -ID:0.57/0.65
• Progreat™Ω (2.8 Fr)- 110/130OD:1/0.93=3/2.8 -ID:0.7
• ABBOT
Veripath Peripheral Guiding Catheter
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Three-Layer Construction
50 cm length
5 catheter shapes
6,7,8 F
014/018
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Hi-Torque Steelcore Peripheral Guide Wire
Hi-Torque Spartacore Peripheral Guide Wire
Hi-Torque Supra Core Peripheral Guide Wire
Hi-Torque Versacore Guide Wire System
• Hi-Torque Steelcore Peripheral Guide Wire
Hi-Torque Spartacore Peri Wire
• Excellent .014" Support with Superb
Steerability and a Soft Shapeable Tip
• Core-to-tip design
• High-support.014" stainless steel shaft
• MICROGLIDE Coating
• PTFE Coating up to distal 7 cm
• Available in 5 and 10 cm Intermediate
Segment Lengths
Hi-Torque Supra Core Peri Wire
• One-to-one torque response designed for
exceptional steerability
• MICROGLIDE coating
• Radiopaque tip designed for visibility during
guide wire placement
• 035" shaft
• Soft Shapeable tip
Hi-Torque Versacore Guide Wire
• Torqueable wire for deliverability through
tortuous or challenging lesions
• Soft shapeable tip designed to for lesion
access
FoxCross .035 PTA Cath
• D-(3-14 mm), L-(20-120 mm), and cath L (50,
80 &135 cm)-OTW
• 50,80,135
• 5-7 F
• Guide wire compatibility: 035
• Nylon Polymer
• JETCOAT coating
Fox sv PTA Catheter
• OTW designed for challenging small vessel
procedures
• Range of BTK and SFA sizes (2-6 mm) 90,150
• Sheath Compatibility:4F for all sizes
• Guide wire compatibility:.014"/.018"
Fox Plus PTA Catheter
• Low Profile
• Compatible with a 5 French sheath up to 7mm
balloons.
• Excellent rewrapping
• Shaft Technology-Adv shaft technology dual
lumen - Rapid inflation and deflation
• JET coated shaft, tip and guidewire lumen.
Reduces friction and facilitates access and
crossing of target lesions
Jostent Peripheral Bare Stent System
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SS Bare balloon-expandable stent
Rec min sheath size: 1F >balloon
Slotted tube with closed cell design
Six in one:
Every bare stent expandable to 6 different D
Post-adjustment of stent size possible
• Standard version: 4-9 mm
Large version: 6-12 mm
Length: 12-58 mm
Omnilink Elite Peripheral Stent System
• Iliac
• compatibility with 6F sheaths across all sizes
• Cobalt Chromium
Absolute Pro LL Peripheral SelfExpanding Stent
• 035
• designed to treat longer SFA lesions
• 120,150
Xpert Self-Expanding Stent
• 4F compatible -speci designed for small
vessels
• Peri vessels from D 2-7 mm
• 018
• Nitinol
• low strut profile
• Conformability
• BOSTON SCIENTIFIC
Amplatz Super Stiff Guide Wire
• For stiffness, strength and stability during
catheter placement and exchange.
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Diameters: 0.035", 0.038"
Lengths: 145cm,180cm, 260cm
Tips Styles: Straight, J, Short
Core Material: Stainless steel
Coating: PTFE
Magic Torque Guide Wire
• Magic Markers spaced at 1cm increments
designed for enhanced visualization and excellent
torque control to meet the challenges of difficult
anatomy
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Diameters: 0.035"
Lengths:180cm, 260cm
Tips Styles: Straight (shapeable)
Core Material: Stainless steel
Coating: Glidex Hydrophilic Coating (tip)
Meier Guide Wire
• Stiff shaft engineered for excellent support, while
flexible tip is designed to reduce the risk of vessel
trauma during diagnostic and interventional
procedures including AAA endovascular graft
procedures.
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Diameters: 0.035"
Lengths: 185cm, 260cm, 300cm
Tips Styles: J, C
Core Material: Stainless steel
Coating: PTFE
Platinum Plus Guide Wire
• Designed for negotiation of tortuous anatomy
and contralateral approaches. Also available in
short taper configuration for access in anatomy
with short distal
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Diameters: 0.014", 0.018", 0.025"
Lengths (cm): 60, 145, 180, 260, 300
Tips Styles: Straight – Long or short taper
Core Material: Stainless steel
Coating: Glidex Hydrophilic
Thruway Guide Wire
• Designed for excellent performance in acutely
angled vessels, such as renals and other
peripheral interventions
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Diameters: 0.014", 0.018"
Lengths (cm): 130, 190, 300
Tips Styles: Straight, J
Core Material: Stainless steel
Coating: Silicone
Sterling ES Balloon Dilatation Cath
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0.014" balloon cath
Ultra-low profile balloon
Both OTW and rapid exchange platforms
.017" tip entry profile
140
Sterling SL Balloon Dilatation Cath
• now in long lengths for below-the-knee specifically designed to meet the challenges of
infrapopliteal procedures
• 014,018
• available in both Over-the-Wire and Monorail
platform
• 90,150
Sterling Balloon Dilatation Catheters
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Breakthrough 4F Profile
Both Over-the-Wire and rapid exchange
40,80,135
Specifically designed for use in renal and
lower extremity arteries
Sterling Monorail Balloon Dil Cath
• Breakthrough 4F Profile.
• carotid, renal and lower extremity
• 40,80,135
• Renegade HI-FLO Microcatheter
• Express LD Iliac Premounted Stent System
• 035
• Express SD Renal Monorail Premounted Stent
System
• 014/018
• Low profile; 6F guide catheter-compatible up
to 6.0mm
• WALLSTENT Endoprosthesis
• recapturable even when up to 87% deployed
• CORDIS
EMERALD Guidewires
• Fixed-Core, PTFE Coated Wires
• 025,035,038
• 150,180
PTA Dilatation
Catheters
PALMAZ Bal-Exp Stent (unmounted)
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Closed cell
SS
Stent D (Expanded) 4-8mm
Stent L (Unexpanded) 10,15,20,29,39mm
Sheath Introducer 6F, 7F
Self-Ex: S.M.A.R.T. CONTROL Iliac
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MicroMesh Geometry, Segmented Design
Nitinol
Stent D 6-10, 12, 14mm (should be 1-2mm >vessel D)
80,120 cm
Maximum Guidewire .035"
Sheath Compatibility 6F (6-10mm), 7F (12-14mm)
Guide Compatibility 8F (6-10mm), 9F (12-14mm)
Self-Ex: PRECISE Carotid Stent System
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MicroMesh Geometry, Segmented Design
Nitinol
Stent D 5-10mm
135cm, Over-the-Wire
Maximum Guidewire .018"
Sheath Compatibility 5.5F (5-8mm diameters), 6F
(9-10mm diameters)
• Guide Compatibility 7F (5-8mm diameters), 8F (910mm diameters)
Self-Ex: PRECISE PRO RX Carotid
Stent
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MicroMesh Geometry, Segmented Design
Nitinol
Stent Diameters 5-10mm
135cm, Rapid Exchange
Maximum Guidewire .014"
Sheath Compatibility 5F (5-8mm diameters), 6F
(9-10mm diameters)
• Guide Compatibility 7F (5-8mm diameters), 8F (910mm diameters
OUTBACK Re-Entry Catheter
• Enables fast, simple true lumen re-entry
without need for IVUS
• Low profile, 6F sheath compatible
• Highly visible "L" and "T" markers- Orient reentry cannula towards true lumen easily,
eliminating need for IVUS
The cannula (large black arrow) is deployed and the 0.014–in. guidewire (small black
arrow) advanced through it. The nose cone (large white arrow) has the radio-opaque
‘‘LT’’ orientation marker. Catheter shaft (small white arrow)
• BIOTRONIK
Cruiser Guide Wire
• 0.014“
• L: 190 cm
• Tip Shape: Straight and J
Cruiser-18
• Hi-support Guide Wire
• 0.018”
• Stiff: 195 cm and 300 cm
Medium: 195 cm and 300 cm
Passeo-18
• Balloon Catheter 0.018” / OTW
• Hydrophobic patchwork coated balloon
ensures a smooth crossing through tortuous
vessels and across high grade stenosis whilst
minimising the risk of slippage during inflation
experienced using hydrophilic coated balloons
Passeo-35
• Balloon Catheter 0.035” / OTW
• Hydrophobic patchwork coated balloon
ensures a smooth crossing through tortuous
vessels and across high grade stenosis whilst
minimising the risk of slippage during inflation
experienced using hydrophilic coated balloons
Elect Explorer
• Balloon Catheter 0.014” / Rx
• EFT (Enhanced Force Transmission) increases
pushability whilst coating improves
trackability and crossability
• Dedicated and unique dimensions for
treatment of infrapopliteal disease.
Dynamic
• Balloon-Expandable Stainless Steel Stent
0.035” / OTW
Dynamic Renal
• Balloon-Expandable Cobalt Chromium Stent
0.014” / Rx
Astron
• Self-Expanding Nitinol Stent 0.035” / OTW
Astron Pulsar
• Self-Expanding Nitinol Stent OTW
• Dedicated and unique dimensions for
treatment of diseases of femoral and
infrapopliteal arteries.