824

Technical Notes
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A Technique for Reforming the Simmons Curved Cerebral

Catheters
Howard L. Berman1 and Thomas J. Cornell1

The Simmons catheter is a commonly used preformed

catheter that has application in both cerebral and visceral
angiography. This catheter is available in various sizes,
thicknesses, and composition of materials. Traditionally, the
Simmons catheter can be reformed in the aortic arch by one
of three commonly taught methods. It can be twisted over
the aortic arch, the leading limb can be advanced out the
leftsubclavian artery, or a tip-deflecting wine can be used.
We suggest a simple additional technique to reform the
Simmons family of curves which has been successful in
reforming catheters of various stiffness up to the 6.5 French
Torcon polyethylene catheter (Cook). The catheter is first
passed oven the aortic arch (fig. 1 A). Turning the catheter
may reform the Simmons curve, but often a tight loop will
form at the knee of the curve (fig. 1 B). Just enough twist is
then constantly applied to the catheter to maintain this loop
without rotating the catheter. The loop is then positioned at
the level of the aortic knob. While torque is applied to keep
the loop firmly formed, an 0.95 mm (0.038 inch), 3.0 mm J
guide wire with a 3.0 cm flexible tip (USCI, Billenica, MA) is
passed through the catheter. The initial floppy part of the
guide wire easily follows the catheter, but as the stiffening
core passes through and out the tip of the catheter, it starts
to enlarge the loop (fig. 1 C). As the loop enlarges, the
catheter is gently advanced; this pushes up the knee of the
curve. Between the advancement of the curve and the
downward movement of the distal limb, the Simmons curve
will be successfully reformed (fig. 1 D). Fig. 1 -A, Simmons curved catheter is advanced over aortic arch. B,
Whenever catheters are advanced into the aortic arch, After twisting catheter, tight loop forms at knee of curve. Knee is then
positioned at aortic knob. C, While applying torque to catheter to maintain
the possibility of trauma to the vessel or embolization, es-
loop, 0.95 mm (0.038 inch), 3.0 mm J guide wire is advanced out catheter
pecially to the great vessels, may occur. To reduce this risk, tip. As guide wire advances, loop enlarges. D, Simmons curve is then
most catheter manipulations using this technique are per- successfully reformed.
formed at the aortic knob distal to the great vessels. Also,
as the Simmons curve is reformed by enlarging a soft
shouldered loop, rather than advancing the tip of the cath-
eter, risk to the arch should be minimal. This technique has REFERENCE
been used extensively at our institution with complete suc- 1. Simmons CR, Tsao EC, Thompson JR. Angiographic approach
cess and without complication, especially for reforming Sim- to the difficult aortic arch: a new technique for transfemoral
mons Types II and III catheters. cerebral angiography in the aged. AJR 1973;1 19:605-610

Received March 5, 1982; accepted after revision May 27, 1982.

, Department of Radiology, University of Texas Health Science Center, 5323 Harry Hines Blvd. , Dallas, TX 75235. Address reprint requests to H. L. Berman.

AJR 139:824, October 1982 0361-803X/82/1394-0824 $00.00 © American Roentgen Ray Society