A catheter system comprising: a guiding catheter, the guiding catheter comprising a flexible body having a lumen therethrough and a deflection wire (38a, 38b); the flexible body having a distal end portion and a proximal end portion, with the proximal end portion being coupled to a handle and the distal end being operably connected to the deflection wire (38a, 38b); the handle comprising an actuator and a handle grip; the handle having a lumen extending through the actuator and the handle grip; the handle grip including a slide (30, 32); the slide (30, 32) being operably coupled to the deflection wire (38a, 38b); an instrument catheter comprising an instrument element, an elongate body having proximal and distal end portions (218, 214) and a manipulation portion; the instrument element being attached to the distal end portion and the manipulation portion being attached to the proximal end of the flexible body; the instrument catheter being disposed within the lumens of the guiding catheter and handle; the proximal portion of the instrument catheter extending through the proximal end of the handle, wherein rotation of the actuator engages the slide (30, 32) causing the slide to displace axially imparting a tensile force to the deflection wire (38a, 38b) thereby causing the distal end portion of the guiding catheter and the portion of the instrument catheter contained therein to deflect from a prior configuration, characterized in that the manipulation portion of the instrument catheter extends beyond the proximal end of the handle; the instrument catheter being capable of rotating within the lumens relative to the guiding catheter; and rotation of the manipulation portion imparts a torque to the elongate body of the instrument catheter thereby causing the instrument catheter to rotate within the lumens of the guiding catheter and handle without substantially changing the deflection of the guiding catheter. a guiding catheter, the guiding catheter comprising a flexible body having a lumen therethrough and a deflection wire (38a, 38b); the flexible body having a distal end portion and a proximal end portion, with the proximal end portion being coupled to a handle and the distal end being operably connected to the deflection wire (38a, 38b); the handle comprising an actuator and a handle grip; the handle having a lumen extending through the actuator and the handle grip; the handle grip including a slide (30, 32); the slide (30, 32) being operably coupled to the deflection wire (38a, 38b); an instrument catheter comprising an instrument element, an elongate body having proximal and distal end portions (218, 214) and a manipulation portion; the instrument element being attached to the distal end portion and the manipulation portion being attached to the proximal end of the flexible body; the instrument catheter being disposed within the lumens of the guiding catheter and handle; the proximal portion of the instrument catheter extending through the proximal end of the handle, wherein rotation of the actuator engages the slide (30, 32) causing the slide to displace axially imparting a tensile force to the deflection wire (38a, 38b) thereby causing the distal end portion of the guiding catheter and the portion of the instrument catheter contained therein to deflect from a prior configuration, characterized in that the manipulation portion of the instrument catheter extends beyond the proximal end of the handle; the instrument catheter being capable of rotating within the lumens relative to the guiding catheter; and rotation of the manipulation portion imparts a torque to the elongate body of the instrument catheter thereby causing the instrument catheter to rotate within the lumens of the guiding catheter and handle without substantially changing the deflection of the guiding catheter.