Backup force of guiding catheters for the right coronary artery in transfemoral and transradial interventions.

OBJECTIVE: We sought to clarify the mechanisms of backup force for right coronary artery intervention.

BACKGROUND: Backup force of a guiding catheter is important for successful percutaneous coronary intervention (PCI); however, little attention has been given to its mechanism.

METHODS AND RESULTS: Backup force of guiding catheters was measured in an arterial tree model. Judkins R, Amplatz L and Ikari R had greater backup force in the transfemoral intervention (TFI) than the transradial intervention (TRI). The primary attachment site of the catheter was the aortic arch in TFI, but it was the brachiocephalic artery in right TRI. This may be a major reason for the different backup force because generation of backup force is governed by the mechanics of the catheter at the attachment site. The Amplatz L and Ikari R had stronger backup force than the Judkins R both in TFI and in TRI because a slight backward motion of the catheter due to device advancement changed the primary attachment site to the reverse side of the aorta or sinus of Valsalva. The primary attachment site of the Ikari L at the power position was the reverse side of the aorta both in TFI and TRI, which was different from other catheters.

CONCLUSIONS: The primary attachment site of the catheter had great impact on the backup force in right coronary interventions. An understanding of the mechanism by which the guiding catheter works in TRI and TFI may help in choosing an appropriate approach site.