Cordis Catheter Use in Coronary Angiography and Angioplasty
Cordis catheters are recommended for coronary angiography and angioplasty in specific clinical scenarios, particularly when performing procedures through 6 French diagnostic catheters for simple lesions during the same session as diagnostic angiography, and for challenging anatomical variants such as Shepherd's Crook right coronary arteries requiring deeper intubation. 1, 2
Clinical Indications for Cordis Catheter Use
Primary Indications
- Combined diagnostic angiography and angioplasty procedures in select patients:
- Patients with suspected restenosis following previous PTCA
- Unstable patients requiring urgent PTCA who cannot be discharged without revascularization
- Patients undergoing PTCA for acute myocardial infarction (targeting only the infarct-related artery)
- Patients with suspected single vessel coronary disease based on clinical presentation 3
Anatomical Considerations
- Particularly useful for:
Technical Advantages
The Cordis Long Brite Tip 6F guiding catheter (I.D. .064") provides:
Benefits of using Cordis catheters in appropriate cases:
- Reduced hospital stay by approximately 30%
- Reduced costs by approximately 15%
- Reduced radiation exposure 3
Clinical Decision Algorithm
Assess patient clinical status:
- Is the patient unstable with suspected single vessel disease?
- Is this a case of suspected restenosis after previous PTCA?
- Is this an acute MI case requiring intervention only on the infarct-related artery?
Evaluate coronary anatomy:
- Is high-quality imaging available for clear lesion assessment?
- Does the patient have a Shepherd's Crook RCA or other challenging anatomy?
- Is the lesion relatively simple and amenable to intervention?
Procedural considerations:
- Has the patient been adequately pretreated with aspirin? 3
- Is surgical backup readily available?
- Has informed consent been obtained for possible combined diagnostic and interventional procedure?
Important Caveats and Contraindications
Absolute Contraindications
- No significant obstructing lesion
- Significant left main coronary disease (>50%) without protection
- No formal cardiac surgical program within the institution 3
Relative Contraindications
- Coagulopathy
- Diffusely diseased saphenous vein grafts without focal dilatable lesion
- Diffusely diseased native coronary arteries with distal vessels suitable for bypass 3
Technical Limitations
- Potential challenges with Cordis 6F diagnostic catheters:
- Insufficient torque control
- Excessive friction when the balloon crosses the tapered end of the diagnostic catheter 1
Post-Procedure Management
- Monitor for evidence of recurrent ischemia
- Ensure appropriate hemostasis at catheter insertion site
- Follow institution-specific protocols for anticoagulation and antiplatelet therapy
- Most patients can be discharged within 24-48 hours after uncomplicated angioplasty 3
Pitfalls to Avoid
- Attempting complex lesions (Type C) through diagnostic catheters
- Performing combined procedures without high-quality imaging systems
- Proceeding with intervention when there is any question about the need for, suitability of, or preference for PTCA versus medical or surgical treatment 3
- Failing to have equipment and services available 24 hours per day for repeat angiography in case of complications 3
Remember that while combined diagnostic and interventional procedures using Cordis catheters can be beneficial in select patients, the decision to proceed should be based on careful evaluation of coronary anatomy with high-quality imaging and appropriate patient preparation.