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Background Judkins catheter is widely used in recent years, for clinical angiography and intervention of most normal coronary arteries, but still incapable to deal with the problems caused by difficult coronary artery (DCA). DCA may influence the procedure of diagnosis and intervention of ischemic heart disease (IHD). To cope with different subtypes of DCA, catheters like Amplatz, EBU, Leya, etc. were bo at that moment, but these standard catheters are used just in special cases and have so many sequences that a local hospital may not be able to keep all of them available routinely at any time. To overcome this problem, some centers perform angiography and intervention using modified catheters based on their own condition and have obtained some experiences. Catheter modification techniques used in these years are reviewed, and are stated respectively based on dealing with different subtypes of DCA to provide practical guidance for clinical diagnosis and intervention for IHD patients having DCA.