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Peripheral angioplasty Overview, Hardware. Frijo Jose A. Vascular Access. Relatively disease-free, without signi Ca Over a bony structure, if possible Angle of entry- 30⁰-45⁰ If access vessel-small/potentially diseased- micropuncture tech preferred. Vascular Access sites.

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vascular access
Vascular Access
  • Relatively disease-free, without signi Ca
  • Over a bony structure, if possible
  • Angle of entry- 30⁰-45⁰
  • If access vessel-small/potentially diseased- micropuncture tech preferred
vascular access sites
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 sites1
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
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 entry- prox to ing ligm
  • Access too close to F bifurc –inadeq working room to selectively cath SFA
vascular access sites2
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 aobifurc
  • CI- aneurysms of PA, pathology of poplitealfossa- Baker’s cyst
brachial artery access
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
  • Itvreq >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
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
guidewire lesion interaction
Guidewire-Lesion 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 wire- once crossed, wire should straighten- advancing a “buckledup” wire- force→embolization
  • Floppy tip “buckledup” with R—backup,redirect,adv -dissect,embolz,wiredamag
catheter diagnostic guiding
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

slide13

slide15

slide18

4F IMPRESS Simmons 1 Catheter 65cm..038

  • Side Ports:N/A
  • Catheter Shape:SIMMONS1
  • French Size:4
slide19

5F IMPRESS Simmons 2 Catheter 65cm..038

  • Side Ports:N/A
  • Catheter Shape:SIMMONS2
  • French Size: 5
sos omni selective catheter
SOS Omni selective catheter
  • Soft, atraumatic, Super-radiopaque tip
  • Reforming in descthoracic aorta – below great vessels rather than transverse arch –safety
  • The catheter should be pulled from the descaointo abdaowith 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
Omni Flush Angiographic Catheter
  • Designed as a single catheter to perform flush aortography, B/L“runoff” studies of lower extremities and to cross aobifurcation 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
slide23

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

slide24

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; ipsiantegrade for interv

3.Selective catheter—Berenstein,Kumpe,Vertebral

Tibial Arteries

1.First choice—contralateral FA

2.Alternative—ipsi retro FA for run-off; ipsiantegrade for interv

3.Selective catheter—Kumpe,Vertebral

guiding catheter vs sheath
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
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
Law of Laplace
  • Circumfer force/tension (T) exerted on wall of an inflatdballn ~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 ballnwill ↑linearly with ↑inflatn P
  • Larger ballns -require ↓P than smaller ballnsto generate substantial dilating forces
  • Larger vessels (Ao) require ↓P to dilate & rupture
slide30

Balloon cath with a D matchngoutflow vessel beyond lesion

  • Balloon length should be > lesion
  • Balloon centered on lesion & inflated slowly
  • Inflation maintained for 20s- deflated- reinflated 3 inflations of 20s
subintimal angioplasty
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
stents
Stents
  • The types of stent used in peripheral interventions:
  • Balloon-expandable
  • Self-expandable
  • Stent graft
balloon expandable stents
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
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 stents1
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
stents1
Stents

Demonstrating the Nitinol self-expandable stent deployment

stent grafts
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
Decision between SE or BE stents in Iliac Lesions
  • Balloon expandable
    • 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)
techniques
Techniques

Retrograde Iliac stent placement

techniques1
Techniques

Cross-over technique

slide42

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 intervention1
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 intervention2
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
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 infrapoplitealarteries
  • 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
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
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
slide48

Infrapopliteal- Balloon Angioplasty

Long balloons (210mm/ tapered)

  • Reducedriskofdissections
  • ( noballoonoverlap)
          • Total intervention /revascularization
          • time significantly shorter
          • Reduced X-ray dose for patients, operators
          • as well as for the assistants
renal artery stenosis
Renal artery stenosis
  • Usually occurs in the proximal 2 cm
  • ~75% of lesions are caused by atherosclerosis
  • 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
Renal artery-Equipment

Diagnostic

  • Wires
    • 0.035” for catheter placement
  • Diagnostic catheter

Intervention

  • Wires
    • 0.014”
    • 0.035” for catheter placement
  • Guiding Sheath
  • Guide Catheter
  • Balloons ( 0.014” compatible)
    • Low profile
    • Undersized for pre-dilation
  • BE-Stents
reanal artery stenting
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
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-ostiallesions - stent protrude (1–2mm) into Ao
  • BES - Ao-ostial locations
  • SES- long segment/more flexibility needed/lesions beyond IMA→external compression
catheters
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
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
beacon tip torcon nb advantage caths
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
Torcon NB Advantage Catheters
  • Sixteen stainless steel wire braid
  • Nylon material
  • Short, flexible atraumatic catheter tip
cxi support catheters
CXI Support Catheters
  • For use in small vessel/superselectiveanatomy for diagn & intervprocedures, inclperipheral 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
slide62

ATB ADVANCE PTA Dilatation Catheter

  • Advance 14LP
  • Advance 18LP
  • Advance 35LP
atb advance pta dilatation catheter
ATB ADVANCE PTA Dilatation Catheter
  • Designed for iliac, renal, popliteal, infrapopliteal, femoral and iliofemoral
  • Also intended for postdilatation of balloon-expandable peripheral vascular stents
  • 40,80,120
advance 14lp
Advance 14LP
  • Low Profile
  • Provides the trackability and pushability to reach even the most remote infrapopliteallesions
  • 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
Advance 18LP
  • Low Profile PTA Balloon Dilatation Catheters
  • Super-flexible tip
  • Advanced rewrap technology
  • 80,135
advance 35lp
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
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: 145,180,260-straight
    • TFE Coated Stainless Steel with Heparin Coating-035: 145,180,260-straight
  • 8cm-flexi tip
amplatz extra stiff wire guides
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 Coating-035: 80,145,180,260-straight & curved
amplatz ultra stiff wire guides
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: 80,145,180-straight
    • TFE Coated Stainless Steel with Heparin Coating-035: 145,180-straight
  • 8cm-flexi tip
roadrunner extra support wire
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
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
CopeMandrilWire Guides II
  • Nitinolmandrilkink 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
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
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
Reuter Tip Deflecting Wire Guide
  • Used with Reuter Tip Deflecting Handle for curving or deflecting catheter tips during selective and superselectiveangiography
  • 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
Double Flexible Tipped Wire Guides
  • Permits alternative use of both ends of wire guide, depending on procedural needs
zilver 518
Zilver 518
  • Vascular Self-Expanding nitinol Stent- iliac arteries
  • Recomm5.0 Fr sheath/7.0 Fr guiding cath
  • Accepts .018 inch wire
zilver 518 rx
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
Zilver 635
  • Vascular Self-Expanding Nitinol Stent
  • Recommended 6.0 Fr sheath/8.0 Fr guiding catheter size
  • Accepts .035 inch diameter wire guide
slide83

Guiding Sheaths (5-8 Fr)PinnacleDestination

  • 5-8 F
  • 45,65,90
  • Hydrophilic coating
  • All dilators are 0.038" wire compatible
glidewire
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

BoliaCurve Glidewire

GlidewireAdvantage™

Small Vessel Guidewires(0.018"-0.025")

Glidewire Standard and Shapeable Tip

Glidewire GT Super-Selective

Glidewire Gold

slide89

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
slide91

Microcatheters

  • Progreat™ (2.4 Fr, 2.7 Fr)- 110/130- OD:0.97/0.9=2.9/2.7 -ID:0.57/0.65
  • Progreat™Ω(2.8 Fr)- 110/130- OD:1/0.93=3/2.8 -ID:0.7
veripath peripheral guiding catheter
Veripath Peripheral Guiding Catheter
  • Three-Layer Construction
  • 50 cm length
  • 5 catheter shapes
  • 6,7,8 F
  • 014/018
slide96

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 spartacore peri 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
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
Hi-Torque Versacore Guide Wire
  • Torqueablewire for deliverability through tortuous or challenging lesions
  • Soft shapeable tip designed to for lesion access
foxcross 035 pta cath
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
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
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
Jostent Peripheral Bare Stent System
  • 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 DPost-adjustment of stent size possible
  • Standard version: 4-9 mmLarge version: 6-12 mmLength: 12-58 mm
omnilink elite peripheral stent system
Omnilink Elite Peripheral Stent System
  • Iliac
  • compatibility with 6F sheaths across all sizes
  • Cobalt Chromium
absolute pro ll peripheral self expanding stent
Absolute Pro LL Peripheral Self-Expanding Stent
  • 035
  • designed to treat longer SFA lesions
  • 120,150
xpert self expanding stent
Xpert Self-Expanding Stent
  • 4F compatible -specidesigned for small vessels 
  • Peri vessels from D 2-7 mm
  • 018
  • Nitinol
  • low strut profile
  • Conformability
amplatz super stiff guide wire
Amplatz Super Stiff Guide Wire
  • For stiffness, strength and stability during catheter placement and exchange.
  • 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 Torque Guide Wire
  • Magic Markers spaced at 1cm increments designed for enhanced visualization and excellent torque control to meet the challenges of difficult anatomyDiameters: 0.035"
  • Lengths:180cm, 260cm
  • Tips Styles: Straight (shapeable)
  • Core Material: Stainless steel
  • Coating: GlidexHydrophilic Coating (tip)
meier guide wire
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.Diameters: 0.035"
  • Lengths: 185cm, 260cm, 300cm
  • Tips Styles: J, C
  • Core Material: Stainless steel
  • Coating: PTFE
platinum plus guide wire
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 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: GlidexHydrophilic
thruway guide wire
Thruway Guide Wire
  • Designed for excellent performance in acutely angled vessels, such as renals and other peripheral interventionsDiameters: 0.014", 0.018"
  • Lengths (cm): 130, 190, 300
  • Tips Styles: Straight, J
  • Core Material: Stainless steel
  • Coating: Silicone
sterling es balloon dilatation cath
Sterling ES Balloon Dilatation Cath
  • 0.014" balloon cath
  • Ultra-low profile balloon
  • Both OTW and rapid exchange platforms
  • .017" tip entry profile
  • 140
sterling sl balloon dilatation cath
Sterling SL Balloon Dilatation Cath
  • now in long lengths for below-the-knee - specifically designed to meet the challenges of infrapoplitealprocedures
  • 014,018
  • available in both Over-the-Wire and Monorail platform
  • 90,150
sterling balloon dilatation catheters
Sterling Balloon Dilatation Catheters
  • 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
Sterling Monorail Balloon DilCath
  • Breakthrough 4F Profile.
  • carotid, renal and lower extremity
  • 40,80,135
slide122

Express SD Renal Monorail Premounted Stent System

  • 014/018
  • Low profile; 6F guide catheter-compatible up to 6.0mm
slide123

WALLSTENT Endoprosthesis

  • recapturable even when up to 87% deployed
emerald guidewires
EMERALD Guidewires
  • Fixed-Core, PTFE Coated Wires
  • 025,035,038
  • 150,180
palmaz bal exp stent unmounted
PALMAZ Bal-Exp Stent (unmounted)
  • 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
Self-Ex: S.M.A.R.T. CONTROL Iliac
  • MicroMeshGeometry, 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
Self-Ex: PRECISE Carotid Stent System
  • MicroMeshGeometry, 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 (9-10mm diameters)
self ex precise pro rx carotid stent
Self-Ex: PRECISE PRO RX Carotid Stent
  • MicroMeshGeometry, 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 (9-10mm diameters
outback re entry catheter
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 re-entry cannulatowards true lumen easily, eliminating need for IVUS
slide133

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)

cruiser guide wire
Cruiser Guide Wire
  • 0.014“
  • L: 190 cm
  • Tip Shape: Straight and J
cruiser 18
Cruiser-18
  • Hi-support Guide Wire
  • 0.018”
  • Stiff: 195 cm and 300 cmMedium: 195 cm and 300 cm
passeo 18
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
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
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
Dynamic
  • Balloon-Expandable Stainless Steel Stent 0.035” / OTW
dynamic renal
Dynamic Renal
  • Balloon-Expandable Cobalt Chromium Stent 0.014” / Rx
astron
Astron
  • Self-Expanding Nitinol Stent 0.035” / OTW 
astron pulsar
Astron Pulsar
  • Self-Expanding Nitinol Stent OTW
  • Dedicated and unique dimensions for treatment of diseases of femoral and infrapopliteal arteries.