The Corsair microcatheter (Asahi Intecc, Japan) [5] has a “Shinka” shaft constructed with 8 thin wires wound with two larger wires, facilitating torque transmission (Fig. 3.1a). Its inner lumen is lined with a polymer that enables contrast injection and facilitates wire advancement. Moreover, the distal 60 cm of the catheter are coated with a hydrophilic polymer to enhance crossability. The tip is tapered and soft, contains tungsten powder to enhance visibility, and has a platinum marker coil 5 mm from the tip. The Corsair catheter is advanced by rotating in either direction, however it is braided to have better power when rotated counterclockwise. The catheter should not be over-rotated (>10 consecutive turns without release) to avoid deformation, entrapment or tip separation with the body of the catheter. The Corsair may have to be replaced if resistance to wire advancement is felt, especially after prolonged use (currently known as “Corsair fatigue”).

The Turnpike catheter (Vascular Solutions, US) is considered by many operators as an improved version of the Corsair catheter, with better coverage of the coils by the polymer tapered tip, reducing the risk of tip separation with the shaft of the catheter. Clinical experience is however limited. To date, most operators found the catheter to be stiffer than the Corsair. It is therefore best suited for septal than in epicardial collaterals, or for antegrade work.

The Finecross microcatheter (Terumo, Japan) has the lowest crossing profile available (1.8 Fr distal tip), stainless steel braid to enhance torquability and a marker located 0.7 mm from the tip (Fig. 3.1b). It is particularly useful for navigating tortuous epicardial collaterals, and is still the preferred antegrade microcatheter for many operators.

The Venture catheter (Vascular Solutions, US, Fig. 3.1c) has an 8 mm radiopaque torquable distal tip with a bend radius of 2.5 mm [6–11]. By clockwise rotation of a thumb wheel on the external handle the tip can be deflected up to 90°. Rotating the entire catheter, enables steering in all planes. The Venture catheter is especially useful for CTOs after a severe bend, for example ostial circumflex CTOs [12]. The Venture catheter is compatible with 6 Fr guiding catheters and with 0.014″ guidewires. However, because of high shaft profile it cannot be removed using a “trapping balloon technique” unless an 8 Fr guide catheter is used [11].

The MultiCross catheter (Fig. 3.1d) is a tri-lumen support catheter with a nitinol scaffold to facilitate 0.014″ guidewire access across complex lesions. The scaffold anchors and centers the catheter to provide the operator with three separate 0.014″ lumen options. The clinical experience with this catheter is limited.

The Prodigy catheter (Fig. 3.1e) has an elastomeric anchoring balloon mounted at the distal end that can expand up to 6 mm diameter [13]. The inflation lumen has a pressure relief valve that limits the inflation pressure to 1 mm Hg, anchoring the catheter in place while minimizing the risk for proximal vessel injury. The clinical experience with this catheter is also limited.