Guiding catheter exchange during coronary angioplasty

A new technique to exchange one angioplasty guiding catheter for another with the guide wire in place and across a coronary artery stenosis has been developed to decrease the dangers of having to recross the stenosis with a guide wire. This technique utilizes a regular extended angioplasty guide wire and enables the exchange of guiding catheters during the angioplasty procedure. In 683 consecutive angioplasty procedures by one operator, this technique has been attempted 57 times in 43 patients (6.3%) and has been successful 51 times (90%). The only failures were when the second catheter had a large or open curve (left Amplatz II, 5/22 unsuccessful or multipurpose, 1/3 unsuccessful). There have been no complications. We conclude that exchange of a guiding catheter over a guide wire by the method described is safe and helpful in cases where different guiding catheters are needed for back-up power once the lesion has been crossed with a guide wire.