Transfemoral use of the guideLiner catheter in complex coronary and bypass graft interventions

Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report

Guide-catheter-induced ostial coronary artery dissection is a feared complication of percutaneous coronary intervention, but thankfully the incidence is low. We describe a case of catheter-induced ostial dissection of the left internal mammary artery (LIMA) with multiple radial jump grafts during percutaneous coronary intervention of radial graft bifurcation disease via the LIMA. The dissection led to loss of flow and profound haemodynamic compromise and cardiac arrest as the LIMA supplied the majority of the myocardium in this patient. Intravascular ultrasound was not immediately available, so an Export AP thrombus aspiration catheter (Medtronic) was used over the coronary wire in place to allow the injection of contrast while simultaneously pulling back on the catheter to delineate the extent of the dissection and guide accurate drug-eluting stent placement. The report is a cautionary tale to the reader to treat the LIMA with respect and think long and hard before considering any interventional procedure that uses the LIMA as a conduit.

"Catheter hole support": a novel technique for increasing guide catheter support

Percutaneous coronary interventions (PCI) in the setting of tortuosity, calcification, and some types of coronary takeoffs can be challenging. In such cases, the choice of strategies that promote optimal catheter support is essential for the success of the procedure, by facilitating the delivery of the equipment. We have developed a new support technique: "Catheter Hole Support Technique" is a simple, low-cost, and widely available technique that effectively increases catheter support and system stability. To perform the technique, all that is needed is a hole in the catheter at the right spot, made by a 22G needle and a 0.018" shapeable tip support guidewire. We report the steps of this new technique in a successful Right Coronary Artery (RCA) PCI, in the context of a non-ST-elevation myocardial infarction (NSTEMI).

GuideLiner Balloon Assisted Tracking for deep cathether intubation to address challenging distal coronary lesions

As the medical treatment and survivability of coronary artery disease improve, patients requiring catheter-based coronary intervention present with increasingly challenging coronary anatomy. Navigating complicated coronary anatomy requires a diverse armamentarium of techniques to reach distal target lesions. Here, we discuss a case in which we used GuideLiner Balloon Assisted Tracking, a technique formerly used to achieve difficult radial access, to facilitate delivery of a drug-eluting stent to a challenging coronary target.

Techniques to Overcome Difficulty in Device Deliverability to Lesion in Complex PCI

Percutaneous Coronary Intervention (PCI) has revolutionized the management of Coronary Artery Disease and has become the preferred modality of revascularization in a majority of cases. Nevertheless, situations are encountered frequently where device deliverability to coronary lesions entails technical difficulties due to varied anatomies and lesional complexities like tortuosity, calcifications, length of lesions and vessel morphology. While continuous technological refinements are occurring in PCI hardware armamentarium and stent designs, a number of techniques and their modifications and variations have evolved to increase the applicability of PCI to difficult lesions. The present article envisages a thorough review of all aspects of improving successful device deliverability in complex PCI with prominent emphasis on increasing the backup support of Guide Catheters which is the primary factor of success in difficult coronary lesions.

Anchor-balloon technique to facilitate stent delivery via the GuideLiner catheter in percutaneous coronary intervention

AIM

The GuideLiner (GL) is a widely used catheter primarily in complex percutaneous coronary intervention (PCI). Deep seating of the GL and distal stent placement may be facilitated by the anchor-balloon technique (ABT).

METHODS

We aimed to prospectively analyze procedural details, technical success, complications and in-hospital outcome in patients who underwent PCI using the GL catheter and the ABT.

RESULTS

A total of 118 patients underwent PCI with the aid of the GL and ABT. Procedure success rate was 95% (112/118) and only seven patients (5.9%) encountered complications. ABT was indicated and successfully used in 29 patients (25%).

CONCLUSION

GL and ABT successfully aided stent delivery in unfavorable and heavily calcified lesions which otherwise may have been considered unsuitable for PCI.

Interventional Management of "Balloon-Uncrossable" Coronary Chronic Total Occlusion: Is There Any Way Out?

It has been estimated that coronary chronic total occlusion (CTO) is encountered in 15 to 20% patients referred for coronary angiography (CAG). The success of percutaneous coronary intervention (PCI) of CTO can be attributed to the vast array of hardware that has now become available and also to the vastly enhanced operator expertise. It is however realistic to state that despite the tremendous increase in the rate of success, there then comes a subset of CTO where PCI attempts fail. The reason for such failures given that other variables remain constant is the inability to cross the CTO lesion. This can be due to a failure to cross the lesion with a guide wire (despite guide wire escalation). The second cause of failure is the inability to cross the lesion with a balloon (balloon-uncrossable [BU] CTO). This can occur despite the successful placement of a guidewire in the distal true lumen. The BU lesions contribute 2% to 10% of CTO PCI failure cases. The author attempts to present a creative solution to assist crossing such lesions.

Successful percutaneous coil embolization of a severely tortuous coronary artery fistula using the mother-child-grandchild technique via a GuideLiner catheter

Coronary artery fistula is an uncommon congenital disease that requires invasive treatment for symptomatic patients. Although percutaneous intervention has become the popular treatment option, surgical treatment is preferred for severely tortuous coronary artery fistulas. We report a case of an extremely tortuous coronary artery fistula successfully treated with the support of the GuideLiner catheter and the mother-grandchild technique.

Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention

BACKGROUND

Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system. There is paucity of data about the efficacy of this device in complex PCI. Therefore, we aim to report the indications, success, and efficacy of GuideLiner use in treating complex lesion subset in the present study.

METHODS

We collected data from all patients in whom the GuideLiner was used to facilitate PCI between April 1, 2011 and December 31, 2014 at a tertiary referral center in Toronto, Canada. Demographic and procedural data were obtained from an institutional prospective data registry. Indications for use of the GuideLiner, and angiographic and procedural data specific to the device were also collected.

RESULTS

The GuideLiner was utilized in 307 (317 lesions) of 6105 PCI procedures performed at our institution during the study period. The mean age was 68.4 ± 11.2 years and 82% were male. The majority of lesions were types B2 or C (98%), calcified (86.3%), with proximal tortuosity (88.6%). The overall technical success rate of the GuideLiner was 88%. The procedural success rate was 98.7%. The complication rate was low (1.6%).

CONCLUSIONS

Use of the GuideLiner catheter facilitated successful completion of PCI procedures in a majority of patients with complex lesions. Operators should be aware of the potential complications associated with GuideLiner use.

Guide extension, unmissable tool in the armamentarium of modern interventional cardiology. A comprehensive review

Due to the aging population undergoing percutaneous coronary intervention (PCI), interventional cardiologists are confronted daily with treatment of lesions with complex anatomy. Despite improvements in stent devices and PCI techniques, these lesions remain a challenge in terms of procedural success. Guide-extensions (GE) are coaxial "mother and child" catheters employed to facilitate device delivery but they can be used in many different complex scenarios. A comprehensive review of the possible applications of GE and of the GuideLiner™ (GL), the most widely used GE device, is missing. We therefore aim to provide a comprehensive review of all the potential applications of the GL and other GE devices, describe its limitations as well as tips and tricks for successful usage of this GE catheter.

GuideLiner catheter application in complex coronary lesions: experience of two centers

OBJECTIVE

GuideLiner catheter provides adequate back-up support and a coaxial guide engagement for stent delivery in complex coronary anatomies. In this study, we aimed to present one of the largest series of experience with GuideLiner catheter utilized for challenging percutaneous coronary interventions in two centers.

METHODS

We retrospectively collected the coronary angiography records of 64 patients between January 1, 2012 and August 1, 2014 in whom conventional techniques failed for stent delivery and 5-in-6 Fr GuideLiner catheter was used for this purpose. The data were assessed in terms of the lesion characteristics, procedural success, and complications. Descriptive statistics and frequencies were used in statistical analyses.

RESULTS

The mean age of the patients was 69.8±10.0 years. Femoral approach was employed in all cases. Lesions were mostly (90.6%) class B2 or C according to the AHA/ACC lesion classification. The GuideLiner catheter was mainly used to increase back-up of the guide catheter (85.9%), and in 95.3% of all cases, the procedure was successful. The mean depth of the GuideLiner catheter intubation was 30.3±21.6 mm. None of the patients had coronary dissection or major complications.

CONCLUSION

In this study, we presented a large registry of two centers used the GuideLiner catheter. The device effectively allowed stent delivery in challenging lesions, where conventional techniques have failed, without major complications.

Update on Coronary Chronic Total Occlusion Percutaneous Coronary Intervention

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved during recent years. High success rates are being achieved by experienced centers and operators, but not at less-experienced centers. Use of CTO crossing algorithms can help improve the success and efficiency of these potentially lengthy procedures. There is a paucity of clinical trial data examining clinical outcomes of CTO PCI, which is critical for further adoption and refinement of the procedure. We provide a detailed overview of the clinical evidence and current available crossing strategies, with emphasis on recent developments and techniques.

Did the use of the Guideliner V2(TM) guide catheter extension increase complications? A review of the incidence of complications related to the use of the V2 catheter, the influence of right brachiocephalic arterial anatomy and the redesign of the V3(TM) Guideliner and clinical outcomes

Objective

We sought to investigate the incidence of complications associated with V2 Guideliner, understand the mechanisms and evaluate the impact of alterations made to the V3 Guideliner.

Methods

Retrospective analysis of consecutive cases employing V2 Guideliner from two university teaching hospitals. Complications were identified, analysed and classified into major versus minor ones. To understand the potential anatomical mechanism of these complications, analysis of normal great vessel anatomy was undertaken in separate cohort of patients undergoing cardiac catheterisation via right radial approach. Further analysis of consecutive cases employing V3 Gudieliner took place and the incidence of complications were compared between V2 and V3 groups.

Results

Total of 188 cases of V2 Guideliner use were identified. One major complication was reported (coronary dissection). Proximal collar interaction and stent damage occurred in 19 cases (10%). Anatomical data suggest that extending the V2 Guideliner tubing sited the proximal collar of the device in the brachiocephalic/subclavian artery, a potential site of tortuosity and potential cause of the Guideliner proximal collar-stent interaction. Further analysis of 124 cases of V3 Guideliner use demonstrated no cases with proximal collar-stent interactions, one case of longitudinal stent deformation and two incidents of stent interaction with the distal edge of the V3 Guideliner.

Conclusions

We have demonstrated a higher incidence of V2 Guideliner complications compared to previous series. The change in design of the V2 Guideliner was a likely contributor but the modifications with V3 Guideliner appear to have ameliorated this issue.

Usefulness and safety of a guide catheter extension system for the percutaneous treatment of complex coronary lesions by a transradial approach

OBJECTIVE

The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions.

MATERIALS AND METHODS

The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques.

RESULTS

Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication.

CONCLUSION

Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded.

Percutaneous Treatment of Coronary Chronic Total Occlusion Part 2: Technical Approach

Dual injection is recommended for nearly all chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to determine the optimal crossing strategy and guide wire advancement into the distal true lumen. Strategies that provide enhanced guide catheter support (such as long sheaths, large-bore guiding catheters, use of guide catheter extensions, and anchor techniques) are important for maximising the success rate and efficiency of CTO PCI. Use of a microcatheter or over-the-wire balloon is strongly recommended in CTO PCI for enhancing the penetrating power of the guidewire, enabling change in tip shape and allowing guidewire change (stiff CTO guidewires are not optimal for crossing non-occluded coronary segments). Adherence to a procedural strategy that standardises CTO technique and facilitates procedural success is recommended. Such a strategy would permit stepwise decision-making for antegrade and retrograde methods; inform guidewire selection; and incorporate alternative approaches for instances of initial failure. Given the paucity of long-term outcomes with use of novel crossing techniques (antegrade dissection/re-entry and retrograde), antegrade wire escalation is the preferred CTO crossing technique, if technically feasible. Using measures to minimise radiation exposure (including but not limited to use of 7.5 frames per second fluoroscopy and use of low magnification) and contrast administration is recommended. CTO PCI is best performed at centres with dedicated CTO PCI experience and expertise. Use of crossing difficulty prediction tools, such as the J-CTO score, can facilitate the selection of cases with a high likelihood of quick crossing that can be attempted at less experienced centres.