Use of Ikari-Curve Left Guiding Catheters During Balloon Pulmonary Angioplasty May Improve Branch Access

balloon angioplasty
The use of Ikari-curve left guiding catheters during balloon pulmonary angioplasty was found to allow access to branches not accessible with conventional guiding catheters.

The use of Ikari-curve left (IL) guiding catheters in balloon pulmonary angioplasty (BPA) was found to allow access to branches not accessible with conventional guiding catheters, according to the results of a retrospective analysis published in the International Heart Journal.

The data, including clinical outcomes, of 40 patients undergoing a total of 202 BPA (IL: mean age, 61.1±13.8 years; 59% women; non-IL: mean age, 60.0±15.1 years; 71% women) between 2016 and 2019 were examined. IL guiding catheters were used in patients undergoing initial BPA for the left lung and for the right pulmonary artery (99 sessions). In both groups the median number of BPA sessions was 4. Lung injury was defined as bleeding from pulmonary arteries other than in rt.A4+5, rt.A7, lt.A3, lt.A4+5, or lt.A8 branches.

The frequency of IL guiding catheter use increased at the hospital from 1 session in 2016 to 10 in 2017, 37 in 2018, and 51 in 2019.

Patients receiving BPA with an IL vs non-IL catheter had more branches treated (15 vs 10, respectively; P <.0001). The average time for treatment of each branch was lower in the IL vs non-IL group (4.4±2.7 minutes vs 7.4±8.0 minutes, respectively; P =.0005).

Lung injuries were observed in 4.0% of participants in the IL group vs 11.7% of patients in the non-IL group (P =.07). Lung injuries were treated with increased oxygen (IL: n=1; non-IL: n=2), infiltrating a gelatin sponge (IL: n=1; non-IL: n=2), and adding a balloon or wedge-guiding catheter (IL: n=2; non-IL: n=8).

The success rate of introduction into branches was greater in procedures in which IL vs non-IL catheters were used (rt.A4+5: 84.4% vs 57.5%, respectively; rt.A7: 46.9% vs 7.5%, respectively; lt.A4+5: 90% vs 62.5%, respectively; P <.05 for all; non-significant: Lt.A3, 82.9% vs 70.8%, respectively; and Lt.A8, 75.7% vs 62.5%, respectively).

This study was limited by the lack of use of other similar catheters (eg, Judkins left guiding catheter).

“The IL guiding catheter may be useful for BPA insertions in which it is difficult to advance a conventional guiding catheter into some vessel branches. This technique improves the safety of BPA,” concluded the study authors.


Minatsuki S, Kiyosue A, Kodera S, et al. Novel balloon pulmonary angioplasty technique for chronic thromboembolic pulmonary hypertension. Int Heart J. 2020;61(5):999-1004. doi:10.1536/ihj.20-280