Fail Safe Guide to Access Routes and Guide Catheters in Acutely Unwell Patients - Dr. Amarjit Sethi

Summary

Amarjit Sethi outlines options for vascular access and guiding catheters in specific situations in ACS patients

• How to deal with complex and high-risk patients
  • Cariogenic shock
  • Multi vessel disease
  • Last remaining coronary artery
  • Large area of myocardium at risk
  • Impaired systolic function
• How to prepare your access with regards to specific considerations
  • Central venous access - delivery of inotropes, temporary pacing wires
  • Multiple arterial access - circulatory support devices such as IABP
  • Radial versus femoral access
• How to limit access-related complications
• How to choose your guide catheter for specific situations
  • Femoral or radial
  • French size (5F guides helpful with small radial arteries but limits the amount of equipment that can be used - i.e thrombus aspiration, rotablation)
  • Aortic width
  • Lesion location and characteristics (distal lesion, tortuously, calcification)
  • Side holes or not
  • Fitting for the coronary
  • Special scenarios - IMA for LIMA PCI, MPA for vein-graft
• Get comfortable with your choice of guide catheter for most situations ("workhorse guide catheter")