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68 PART III Wires Technology
12 Saito S, Miyake S, Hosokawa G et al. Transradial coro-
nary intervention in Japanese patients. Catheter
Cardiovasc Interv 1999; 46: 37–41.
13 Saito S, Tanaka S, Hiroe Y et al. Comparative study on
transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the test for myocardial infarction
by prospective unicenter randomization for access sites
(TEMPURA) trial. Catheter Cardiovasc Interv 2003; 59:
26–33.
14 Takahashi S, Saito S, Tanaka S et al. New method to
increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv 2004; 63:
452–456.
9
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CHAPTER 9
Microcatheters: Characteristics and
Use
John D. Hung1,* & James C. Spratt
1
Liverpool Heart and Chest Hospital, Liverpool University Foundation Trust, UK
2
St George’s University Hospitals NHS Foundation Trust, London, UK
* Corresponding author
Introduction
Microcatheter (MC) engineering has developed significantly in recent years, as indications for their use
have continued to expand. In the era of complex coronary intervention, microcatheters are an essential tool
for all interventional cardiologists and a working (or
even advanced) knowledge of their characteristics is
essential to use them effectively and safely.
Whilst originally used for simple wire exchange,
microcatheters have evolved into essential tools in
several diverse scenarios. In chronic total occlusion
(CTO) PCI, multiple MCs are now available to facilitate antegrade wiring and retrograde approaches, each
with unique properties. Dual lumen MCs are useful in
side branch wiring and maintaining main vessel position, as well as in targeted drug delivery to the distal
vessel or coronary microvasculature. Angulated
microcatheters have been developed to facilitate wiring around tortuous vessels, and management of small
vessel perforation or vein graft occlusion can be performed comfortably by delivery of helical coils.
Microcatheters should be thought of as tubular
extensions of the guide catheter, another step beyond
a guide extension catheter. This allows the base of
operations to move closer and with increased control.
In so doing they provide increased wiring support,
stability, and the ability to confidently maintain position within the vessel, facilitating rapid wire exchange
and without losing any ground.
Critically, MCs should be chosen empirically, based
on the task at hand. Familiarity with equipment is
undoubtedly an important factor and should influence selection, but other variables such as proximity
to the catheter lab, favored manufacturers or color
should not be important considerations. Like all
2
equipment in intervention, MCs are developed by
engineers with deliberate properties and specifications to perform particular tasks. These differences
inevitably make them very good at some applications
but much less good at others. For example, a coiled
and threaded high penetration MC like the Turnpike
Spiral is best suited to penetrating the tough proximal
cap of a CTO, due to its size, strength, and external
nylon coils. These properties make it pushable and
supportive, to give increased back-up and penetrative
force in traversing resistant plaque. However, these
same properties would work against it in navigating
tortuous retrograde collaterals, when the features of
trackability and lubricity are required. The reverse
would be true of the Caravel, which is smaller and
more flexible. None of these properties would be
needed for a simple wire exchange.
Microcatheters can therefore be classified in several
ways according to their design and properties. No system can neatly divide them into definite exclusive categories, but broad groupings into big or small,
pushable or trackable, coiled or non-coiled, tapered or
non-tapered, can help to narrow down to the few
which are appropriate, or even better – ideally suited
to the application in question.
To choose the right MC for the task therefore
requires in-depth knowledge of each. It is critical to
understand how they’re constructed, what properties
they therefore have, and what their intended uses are.
This chapter will describe each of the key characteristics of selected microcatheters, describe specific
examples for use, and how to use them safely and
effectively. This section should increase understanding of modern-day MCs and provide an aide-memoire to the modern-day CTO operator.
Chronic Total Occlusions: A Guide to Recanalization, Third Edition. Edited by Ron Waksman and Shigeru Saito.
© 2024 John Wiley & Sons Ltd. Published 2024 by John Wiley & Sons Ltd.
69
70 PART III Wires Technology
Characteristics
Several key characteristics allow classification of
microcatheters, although there is overlap, and multiple potential classifications exist (Figure 9.1).
Size: The tip of a microcatheter may be tapered, and
the severity of the taper can vary. Tapered microcatheters are more suited to penetration, with better
lesion engagement and crossability. Microcatheters
which are larger at the tip and in the shaft are naturally stiffer, but increased size and stiffness results
in less trackability when dealing with tortuosity.
The Corsair Pro has a marked taper going from
0.42 mm (1.2Fr) at the tip to 0.87 mm (2.6Fr) in
the distal shaft, making it a good choice for most
antegrade CTO approaches.
Push Force: Pushability is dependent on catheter
rigidity and the ability to apply co-axial force. The
Turnpike Gold is designed for maximal stiffness to
deal with resistant lesions, with a large, tapered tip
0.71 mm (2.1Fr). It is therefore a very strong and
supportive choice for antegrade CTO approaches
but would not be useful for retrograde crossing or
simple wire exchanges.
Torque : Ability to torque a microcatheter both improves
trackability and allows catheters with external threads
to “drill” into a lesion increasing support. Coiled
microcatheters are designed for torquing, but braided
microcatheters should not be rotated and carry a risk
of fracture if over rotated. The Finecross and Caravel
should be cautiously rotated when advanced, as rotation reduces friction, but the coiled microcatheters
should be actively spun and critically only in the
“right” direction (clock or anti-clock). Torquing MC
to advance through a lesion should be performed by
right hand index finger and thumb spin the hub, gripping the guide wire between the little finger and
hypothenar eminence.
Lubricity: The majority of microcatheters have some
lubricious coating to reduce friction and improve
trackability.
Trackability: Flexible microcatheters with a lubri-
cious coating will be more trackable, but there is a
trade off with push force. The Caravel MC is small
and lubricious, which makes it a good choice for
tortuous retrograde collaterals, but less well suited
to penetrating a hostile lesion in antegrade
approaches.
Threads: Modern CTO microcatheters with external
nylon threads are designed to “screw” into CTO
lesions. This fixes the MC in situ and gives
improved support for wiring and improves pushability for crossing. Importantly they are directional
and the direction of torque is different between
manufacturers.
Table 9.1 summarises key microcatheter features,
including out diameters and torque direction.
Types
Braided
Braided microcatheters have a soft and flexible tip,
with low-crossing profile, enabling multi-purpose use
for wire exchanges and retrograde collateral crossing.
Due to their non-coiled construction, braided microcatheters should be pushed to advance, not torqued,
to avoid damage to the microcatheter. Small size,
lubricity and flexibility allow good trackability in tortuosity, but the trade-off is less pushability and coaxial force which is needed for crossing more resistant
lesions. Most microcatheters are available in shorter
130cm or 135 cm length for antegrade approaches,
and longer 150cm for retrograde.
Caravel
The Caravel (Figure 9.2) is a braided microcatheter
with a small tip and high flexibility. This enables
improved trackability for small, tortuous collateral
channels and crossability for tight stenoses. It should
not be “over-torqued” as it is not structurally designed
for this, and when impacted into a lesion would risk
damage to structural integrity.
Finecross
The Finecross (Figure 9.3) is a braided, non-tapered
tip microcatheter with a small entry profile. It is useful
for simple wire exchanges, and well-suited to crossing
tight lesions. As with any braided catheter, it should
Figure 9.1 Microcatheter characteristics.
Hydrophilic Threaded Tapered OD tip OD distal OD shaft ID tip ID prox Torque
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Construction
0.62mm (1.9Fr) 0.85mm (2.6Fr) 0.016 0.022 No
0.6mm (1.8Fr) 0.87mm (2.6Fr) 0.018 0.021 No
(1.4Fr)
(1.8Fr)
0.87mm (2.6Fr) 0.93mm (2.8Fr) 0.015 0.018 Anti-clock
0.87mm (2.6Fr) 0.93mm (2.8Fr) 0.015 0.018 Anti-clock
(1.2Fr)
0.71m (2.1Fr) 0.95mm (2.9Fr) 0.015 0.019 Anti-clock
(1.2Fr)
0.87mm (2.6Fr) 1.02mm (3.1Fr) 0.015 0.018 Clockwise
(1.3Fr)
1.02mm (3.1Fr) 1.02mm (3.1Fr) 0.015 0.018 Clockwise
(1.6Fr)
0.74mm (2.2Fr) 0.97mm (2.9Fr) 0.015 0.018 Clockwise
(1.6Fr)
0.46mm (1.4Fr) 0.81mm (2.4Fr) – – Clockwise
(1.6Fr)
0.46mm (1.4Fr) 0.71mm (2.1Fr) – – Clockwise
(1.4Fr)
(1.4Fr)
0.71mm (2.1Fr) 0.71mm (2.1Fr) 0.016 0.025 Anti-clock
0.88mm (2.6Fr) 1.0mm (3Fr) 0.016 0.018 Anti-clock
(1.8Fr)
(2.1Fr)
1.07mm (3.2Fr) 1.02mm (3.1Fr) 0.015 0.018 Anti-clock
(2.1Fr)
Name Length1 Length2 Brand Type Shaft
Caravel 135cm 150cm Asahi Braided Braided 70cm, 85cm No Yes 0.48mm
Table 9.1 Microcatheter specifications.
Finecross 130cm 150cm Terumo Braided Braided 70cm,90cm No No 0.6mm
Corsair 135cm 150cm Asahi Coil based Coils 60cm No Yes 0.42mm
Corsair Pro 135cm 150cm Asahi Coil based Coils 60cm No Ye s 0.42mm
135cm 150cm Asahi Coil based Coils 70cm, 85cm No Yes 0.4mm
Corsair Pro
XS
135cm 150cm Teleflex Coil based Braid and 2 coils 60cm Yes Yes 0.53mm
Turnpike 135cm 150cm Teleflex Coil based Coils 60cm No Yes 0.53mm
Turnpike
135cm 150cm Teleflex Coil based Braid and 2 coils 60cm No Yes 0.53mm
Spiral
Turnpike
LP
Mamba 135cm 150cm Boston Coil based Coils 60cm No No 0.46mm
135cm 150cm Boston Coil based Coils 60cm No No 0.46mm
Mamba
Flex
135cm Asahi Penetration Metallic No No Yes 0.61mm
135cm Asahi Penetration Metallic No No Yes 0.70mm
Tornus
2.6Fr
Tornus
2.1Fr
135cm Teleflex Penetration Braid and 2 coils 60cm Ye s Yes 0.71mm
(baby)
Turnpike
Gold
Hydrophilic Threaded Tapered OD tip OD distal OD shaft ID tip ID prox Torque
0.018 – No
1.05mm (3.2Fr) 0.016 0.017 No
0.87mm (2.6Fr) 0.018 – No
0.87mm (2.6Fr)
0.84mm (2.5Fr) /
1.08mm (3.3fr)
0.77mm (2.3Fr) /
1.08mm (3.3Fr)
0.77mm (2.3Fr) /
(1.5Fr)
(1.5Fr)
38cm No Yes 0.5mm
/ 1.08mm
(3.3Fr)
1.08mm(3.3Fr)
(1.5Fr)
80cm No No – – – – – No
Name Length1 Length2 Brand Type Shaft
Table 9.1 (Continued)
Construction
and OTW
Sasuke 145cm Asahi Dual lumen Rapid exchange
135cm IMDS Dual lumen 2 x OTW 18cm No Yes 0.5mm
NHancer
RX
ReCross 140cm IMDS Dual lumen 2 x OTW Distal 0.5mm
tungsten
Directional Platinum/
Directional Platinum tip 24cm No No – 0.75mm (2.2Fr) – – – No
Vascular
Solutions
Vascular
Angled
Supercross
Venture
Solutions
RX
Figure 9.2 Caravel.
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CHAPTER 9 Microcatheters: Characteristics and Use 73
Figure 9.3 Finecross.
not be “over-torqued” particularly when impacted or
entrapped due to the risk of shearing. It is also worthy
of note that the Finecross length is slightly shorter at
130cm, which is helpful when the base of operations
external threads can increase stability within the lesion
but increase the risk of entrapment. Coil based microcatheters are designed to be torqued either clockwise or
anti-clockwise, and this varies by manufacturer.
is distal in the artery to facilitate simpler exchange
with a trapping balloon technique. A new iteration of
the Finecross will be more tapered and with a longer
lubricious segment.
Corsair and Corsair Pro
The Corsair and Corsair Pro microcatheters (Asahi
Intecc) (Figure 9.4) are coiled, tapered, and flexible
microcatheters. Initially designed for dilatation of
Coil-based
Microcatheters with a coiled construction are designed
for higher pushability, torquability, and application of
co-axial force in tortuous anatomy. Their more robust
construction means a larger profile than braided
microcatheters in general, and more penetrative
microcatheters may be less trackable. The addition of
small collateral channels, they are also well suited to
lesion crossing, benefitting from a combination of
good crossability and trackability. The Corsair Pro
was engineered for better torque transmission, with a
smoother transition between shaft and tip and a
“kink-resistant” hub. As with all Asahi microcatheters, they are directional due to their coil construction
74 PART III Wires Technology
Figure 9.4 Corsair and Corsair Pro.
and should only be torqued anti-clockwise to advance.
The Corsair should be rotated in a 4:1 ratio, meaning
4 turns anti-clockwise, then 1 turn clockwise to release
tension. It should not be rotated more than 10 times in
any one direction, to avoid deformation of the
catheter.
Corsair Pro XS
Developing from the Corsair Pro, the XS device
(Figure 9.5) has improved flexibility of the tip enabling enhanced crossability. It also has a longer hydrophilic coating, and is engineered specifically for
trackability making it well-suited to crossing tortuous
and small caliber retrograde channels.
Turnpike and Turnpike Spiral
The Turnpike and Turnpike Spiral MC (Teleflex)
(Figure 9.6) is constructed with 2 coil layers laid down
in opposite directions, to improve kink resistance and
torque transmission even in tortuosity. The coils are
contained within a braid and is covered by polymer
for lubricity. The tip is flexible and tapered, and well
seen on fluoroscopy. Its utility is in penetration of calcific and tortuous CTOs, with enough flexibility to
navigate tortuosity, but maintaining enough push
force to allow forward progress.
The Turnpike Spiral has a 2cm section of external
nylon coils laid in a clockwise direction. When
advanced forward it should be torqued clockwise,
with occasional anticlockwise turns to release tension.
It should be removed by backwards traction with anticlockwise turns.
Turnpike LP
The Turnpike LP (low profile) (Figure 9.7) is specifically designed for navigating retrograde collaterals,
with a narrow distal shaft (0.74 mm, 2.2 Fr compared
with 1.02 mm, 3.1 Fr of Turnpike Spiral). It has a
Figure 9.5 Corsair Pro XS.
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CHAPTER 9 Microcatheters: Characteristics and Use 75
Figure 9.6 Turnpike and Turnpike Spiral.
76 PART III Wires Technology
Figure 9.7 Turnpike LP.
unidirectional coil distally, and should be advanced
clockwise, removed anti-clock.
Mamba and Mamba Flex
The Mamba and Mamba Flex (Boston) (Figure 9.8)
are flexible and constructed with a uni-directional
coil and low crossing profile. The catheters are subtly
different with a slightly smaller proximal shaft in the
flex version, enabling better trackability when retrograde. The Mamba flex is useful for both antegrade
and retrograde applications, particularly lubricious
and therefore useful for crossing calcific and tortuous lesions. The coils are directional and it should be
advanced with clockwise torque.
Penetration
Penetration microcatheters are designed for maximum
support and crossability in resistant lesions using antegrade approaches. They are larger, and less trackable as
a result, and only available in 135 cm lengths. As with
coil based microcatheters each is designed to advance
with rotation in a particular direction.
Tornus and Baby Tornus
The Tornus penetration catheters (Figure 9.9) are stiff
and metallic, designed to enable wiring and crossing
of resistant, calcific lesions. They are constructed with
8 exposed, wrapped metal coils and a long 15cm taper
for maximal support. The larger version of the Tornus
Figure 9.8 Mamba and Mamba Flex.
Figure 9.9 Tornus.
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CHAPTER 9 Microcatheters: Characteristics and Use 77
offers most support with a 2.1 Fr tip, 2.6 Fr distal and
3.0 Fr proximal shaft, but the smaller (baby) Tornus is
also stiff and pushable, just slightly smaller in profile.
No more than 20 turns should be applied in an
anti-clock direction, and due to absence of an inner
coating tip injections are not possible.
Turnpike gold
The Turnpike Gold (Teleflex) (Figure 9.10) is designed
for penetration, with a threaded metallic tip and 2cm
section of nylon coils proximal to it similar to the
Turnpike Spiral. It shares the same internal coil construction, and benefits from stiffness and pushability
for resistant lesions, as always these advantages trade
off with flexibility to deliver co-axial force in tortuosity. It should be reserved for antegrade approaches in
resistant lesions, and as with all Teleflex microcatheters should be advanced with clockwise rotation.
Dual lumen microcatheters
Dual lumen microcatheters (DLMC) are constructed
with a rapid-exchange monorail and an over the wire
(OTW) side port located proximal to the tip. They are
useful for multiple applications in CTO and general PCI:
(1) Access to sharply angulated proximal cap.
The DLMC should be advanced over a workhorse
guidewire positioned in an adjacent side branch,
and an appropriate CTO wire delivered via the
Figure 9.10 Turnpike gold.
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