1. Coronary Angioplasty Balloon Catheter in Medical Applications
Jagvir Singh
MTech. Clinical Engg.

2. History of Coronary Angioplasty
In 1711, Stephen Hales conducted the first cardiac catheterisation of a horse using brass pipes, a glass tube and the trachea of a goose.
WERNER FORSSMAN – First Human Catheterization – 1929
In the early 1940's, Andre F Cournand, working in New York, began utilizing right heart catheterisation for investigation of cardiac function in both normal and diseased patients.
Andreas Gruentzig – First Coronary Angioplasty
Hales is regarded as one of the founders, and perhaps the most important, of plant physiology. In Vegetables Staticks he measured the pressure of sap and the transpiration of moisture from the leaves.
He also took the most important step after Harvey and Malpighi in elucidating circulation. In Haemastatics (published in Statical Essays, 1731) he succeeded for the first time in measuring blood pressure.

3. COMPLETE APPARATUS:
> Needle
Guide Wire
Sheath
Catheter

4. PUNCTURE NEEDLES: Seldinger Needle
Used to cannulate or puncture the artery.
Usual Sizes include
18 ga, 19 ga , 20ga, 21 ga.
The selection of the Size depends on
the guide wire going to be inserted
through that needle port.
Seldinger Needle

5. GUIDE WIRE: Guide-wire structure :
Available in cm length; should be at least 20 cm longer than the catheter to be used
Majority - stainless steel (Majority coated with PTFE (Teflon)
Inner core – Mandrel
Shaft Coiled wire Safety ribbon / wire – Extends the whole length of coil
All wires have a bead at the tip - soldered.

6. DEFINITION:
A catheter is a hollow flexible tube that can be inserted into a body cavity, duct or vessel. Catheters thereby allow drainage or injection of fluids , distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
In most uses a catheter is a thin,
flexible tube: a "soft" catheter;
in some uses,
it is a larger, solid tube: a "hard" catheter.

7. Ideal characteristics of catheters
Better Torque Control
Strength
Radiopacity
Flexible
Atraumatic Tip
Low Surface frictional resistance for good trackability
over guide wire.

8. PARTS OF A CATHETER
BODY
HUB
BODY
TIP
TIP
HUB

9. FRENCH CATHETER SCALE:
The French catheter scale (most correctly abbreviated as Fr, but also often abbreviated as FR or F) is commonly used to measure the outer diameter of cylindrical medical instruments including catheters ,needles etc.
D(mm) = Fr/3 or Fr = D(mm)*3

10. CATHETERS CAN BE BROADLY CLASSIFIED UNDER THESE GROUPS:
DIAGNOSTIC CATHETERS
Used for Angiographs .
GUIDING CATHETERS
Used for Angioplasty.
Guiding catheters are like angiography catheters only difference is that guiding catheters are more stiffer & firm as it carries Balloon catheters, PTCA wires and stent delivery system.
Mild stiffness comes due to the wire braided design.
Good Push ability .
Good Tractability.

11. TYPES OF CATHETERS: CLASSIFICATION : -: Single Hole SIZES :
Catheters can be classified depending on
SIDE HOLES :
-: Single Hole
-:End Hole with side holes.
-:Blocked end with side holes only.
SIZES :
Abdominal – 6-80 cm
Thoracic or Carotid Arteries – cm
NOTE: Size depends on :
> age of the patient
> selective or super selective study
> size of the vessels.
NOTE: Ideal practice is to use the smallest diameter catheter feasible for any particular study to minimize the risk of arterial damage by the procedure.

12. TYPES OF CATHETERS Pigtailed Catheter Cobra Shaped Catheter
SHAPES
Straight Catheter
Pigtailed Catheter
Cobra Shaped Catheter
Side Winder Catheters (Shepherd)

13. Different Catheter Curves For Different Purposes:
> Judkins Left (JL)
> Judkins Right ( JR)
> Judkins Left Short Tip
> Judkins Right Short Tip
> Amplatz Left ( AL)
> Amplatz Right ( AR)
> Left Coronary Bypass
> Right Coronary Bypass
> Cardiac Pigtail
> Multipurpose

14. Judkins Left
Judkins Right
Amplatz Right
Amplatz Left

15. Foleys Catheter (1way, 2way or 3way)
Butterfly Catheters

16. Shape of the Tip :
J Tip / Straight Tip

17. Some Other Types of Catheters:
Hydrophilic Catheters :
Hydrophilic-coated catheters have a layer of polymer coating that is bound to the catheter surface.
The polymer absorbs and binds water to the catheter, resulting in a thick, smooth and slippery surface.
Intermittent Catheters:
Intermittent catheters are hollow tubes used to drain
urine from the bladder.
Pediatric Catheters:
Usually its around 80cm.

18. Catheter construction :
Single layered/Multi layered
Multi layered :
Inner tube - of Teflon / Polyurethane
Middle layer - tube of nylon, woven Dacron, or stainless steel braiding.
External layer - A tube of polyethylene or polyurethane is then heated and extruded over the two inner layers to bond firmly . Radio- opaque material is incorporated by impregnating with barium or bismuth
Ba, Bi soften the catheter ,may produce fine pitting of surface thereby increasing thrombogenicity
Thrombogenicity is reduced by coating with Silicone or any antithrmbogenic materaial

19. Dacron Catheters Materials
Dacron ,Polyurethane, Poly ethylene, Teflon, Polyvinylchloride (PVC)
Dacron
Eg. GL - Goodale Lubin, NIH.
Woven Dacron
Most covered with polyurethane coating to increase surface
stiffness and reduce vascular trauma.
Some angiographic catheters are reinforced with a nylon core.

20. Polyurethane and Poly ethylene(e. g
Polyurethane and Poly ethylene(e.g. Judkins Coronary catheters, Pigtail catheters )
PE is relatively resistant to softening by barium/bismuth and is more easily extruded
can be easily softened by heating for reshaping/special tip configurations
has to be gas sterilized
PU has an excellent memory. This is a desirable feature of super selective catheters whose tip design may be altered during insertion and manipulation.
Softer - which reduces the risk of vascular trauma or perforation.
can be reshaped by immersing in boiling water/or steam I

21. Teflon Stiffest vascular catheters.
Teflon has poor catheter memory - more appropriate for non-selective catheterization.
Eg. Mullins for septal puncture / all sheaths

22. Polyvinyl chloride
PVC catheters are the softest among the catheters available.
Very flexible and therefore ideal for flow directed catheters.
PVC has a high friction coefficient which may reduce the ease of catheter passage and increase the incidence of venous spasm.
They have increased thrombogenicity and very poor memory and high moisture absorbtion – drugs may get absorbed Eg - Atropine.
Examples: Swan-Ganz catheters, Berman angiographic catheter.

23. Two types of medical balloons
High pressure balloons
Moulded to their inflated geometry from non-compliant or low compliant materials that retain their designed size and shape even under high pressure
Low pressure balloons
Moulded in a tubular shape which is then expanded to several times its original size in use. Used primarily for fixation or occlusion.

24. Balloon Materials

25. Manufacturing Balloons
Angioplasty balloons are made by extruding material into a tube shape and then forming the tube into a balloon through a process known as blow moulding. The balloon should have:
– The smallest possible wall thickness
– Burst pressure of more than 15 bar
– Defined pressure and diameter characteristics

26. USES & APPLICATION s OF CATHETERS:
Placement of a catheter into a particular part of the body may allow:
Draining urine from the urinary bladder as in urinary catheterization, e.g., the Foley catheter.
Catheter balloon Valvuloplasty
Drainage of fluid collections, e.g. an abdominal abscess.
Administration of intravenous fluids, medication or parenteral nutrition with a peripheral venous catheter.
Angioplasty , angiography , balloon septostomy, balloon angioplasty.

27. Direct measurement of blood pressure in an artery or vein.
CONTD…
Direct measurement of blood pressure in an artery or vein.
Direct measurement of intracranial pressure.
Administration of anesthetic medication into the epidural space, the subarachnoid space, or around a major nerve bundle such as the brachial plexus.
Subcutaneous administration of insulin or other medications.
A central venous catheter is a conduit for giving drugs or fluids into a large-bore catheter positioned either in a vein near the heart or just inside the atrium.

28. REFERENCES: Wikipedia Google
Websites:
Wikipedia
Google
Books:
Diagnostic and therapeutic Cardiac Catheterization :
Carl J.Pepine
Cardiac Catheterization Angiograhy and Instruments:
W. Grossman, Donald Baim
Cardiac Catheterization methods diagnostic and therapeutic:
Peterson ,Nicod