Coaxial technique for catheterization of the coronary arteries with a very dilated ascending aorta

Super telescopic catheter system parallel to a contralateral stiff guide wire to cross extremely complex pulmonary arteries

Access to complex stenotic pulmonary arteries can be challenging due to their anatomy or secondary to prior multiple surgeries and interventions. Two techniques have been previously described to address this issue: the telescopic catheter-in-long sheath parallel to a stiff guidewire technique and the use of a microcatheter in a telescopic scope. We integrated and modified these techniques creating a super telescopic system with a SuperCross® microcatheter-in-catheter-in-long sheath, parallel to a contralateral stiff guidewire to access a previously repaired and stented left pulmonary artery. The stiff wire support and the 90° flexiblity of the Supercross® microcatheter assembled coaxial to the diagnostic catheter and the long sheath contributed to the successful ballooning and stenting-in-stent of the pulmonary artery.

Telescoping Technique to Engage Left Main Coronary Artery in a Case of Giant Aortic Aneurysm in a Geriatric Patient

We present a case of a geriatric male with giant ascending aortic aneurysm (AAA) who underwent successful coronary angiography using telescoping technique for evaluation his coronary arteries before surgery for AAA. Since the ascending aorta and root were extremely dilated, we knew it would not have been possible to engage the coronaries using regular catheters and standard technique. Hence, telescopic technique was used. Amplatz left 3 (AL3) 7F (French) guide catheter (90 cm) was initially used, and nonselective injection of contrast was done to see the coronary ostium. After that, a 5F multipurpose catheter (110 cm) was telescoped through 7F AL3 guide catheter to engage the ostium of the left main coronary artery. Using this technique, images of coronaries were obtained, and it showed minimal luminal irregularities in major epicardial coronary arteries. The patient underwent successful surgery with aortic valve replacement and excision of aneurysm with graft placement. Although this technique has been described previously in enlarged aortas, this is the first to our knowledge use of telescoping technique in giant aortic aneurysm in a geriatric patient.

Rapid-exchange guide catheter extension for extending the reach of an AL3 guide in a patient with a long, dilated ascending aorta

We describe the use of a rapid-exchange style guide catheter extension to facilitate diagnostic coronary angiography in a patient with a long, dilated ascending aorta. The guide catheter extension is an easy to use device that can extend the reach of 110 cm catheters. There are several advantages to this "mother and child" guide catheter extension over the traditional telescoping catheter approach.

Telescopic catheter-in-long sheath and parallel to a stiff guide wire technique for complex pulmonary artery anatomy

Selective catheterization and procedures in pulmonary arteries may be very challenging. We developed a technique in which an extra-stiff guide wire was placed in a pulmonary artery. Across it a long sheath was placed proximally or controlateral to the lesion to be treated. An angiographic catheter was then placed parallel to the guide wire in a telescopic way within the long sheath. This system facilitated greater stability, allowing fine tuning of catheter position to reach and treat the target lesion. Here, we present five cases in whom this technique was used; a patient with multiple arteriovenous fistulas in a difficult to reach area and four subjects with complex pulmonary artery stenoses.