Chapter 19: Guide Catheters: Selection and Use

Guiding catheter cannulation requires additional skills and expertise when performing percutaneous coronary intervention (PCI) via the radial approach. Understanding features that can lead to inadequate guide fit/support is important to appreciate guide catheter selection and manipulation. Patient characteristics, including age, gender, body habitus, and aorto-subclavian anatomic considerations, can impact guide catheter choice and ease of cannulation. Standard guide catheters for coronary interventions via the radial approach will be discussed in this chapter as well as factors that impact guide catheter use.

Right vs. Left Radial Access

Regardless of whether cardiac catheterization is performed using right or left radial artery access, both strategies have high success rates and low complication rates in current practice. However, subclavian tortuosity is encountered less frequently via the left radial approach. Left-sided approaches require traversing the subclavian artery in order to enter the aorta, whereas right radial access requires navigating both the subclavian and brachiocephalic angulations in order to enter the aorta. This anatomic feature likely explains the shorter fluoroscopy times and learning curve associated with this left-sided access. Therefore, some argue that left-sided transradial approach should be the default method. Historically, the vast majority of interventionists were trained on the right side (femoral and radial), thus it seems unlikely that left-sided approaches will supersede the right in the near future.

Srinivas Yallapragada, MD and Rajiv Gulati, MD, PhD