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Vanezis A. Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report. Interv Cardiol 2023; 18:e27. [PMID: 38213744 PMCID: PMC10782429 DOI: 10.15420/icr.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 01/13/2024] Open
Abstract
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.
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Affiliation(s)
- Andrew Vanezis
- Trent Cardiac Centre, Nottingham City Hospital Nottingham, UK
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2
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Thiele JM, Mathbout M, Fernandes V. GuideLiner Balloon Assisted Tracking for deep cathether intubation to address challenging distal coronary lesions. Glob Cardiol Sci Pract 2023; 2023:e202307. [PMID: 36890839 PMCID: PMC9988303 DOI: 10.21542/gcsp.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- John M Thiele
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad Mathbout
- Division of Cardiovascular Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Valerian Fernandes
- Division of Cardiovascular Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Fischell TA, Payne J, Wehde K, Saltiel FS. A Next-Generation Guide Extension System for Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 32:50-55. [PMID: 33380378 PMCID: PMC10705001 DOI: 10.1016/j.carrev.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guide catheter extension is an integral part of percutaneous coronary intervention (PCI). First generation guide catheter extension devices are monorail, blunt ended tubular structures with limitations. The CrossLiner™ is a next generation guide extension "system" intended to allow safe, deep, coronary intubation. METHODS The CrossLiner was tested in a head-to-head study with the GuideLiner™ and GuideZilla™ in a porcine coronary model, with stenting. Data were collected from 8 coronary vessels from four animals, to evaluate the ability to deeply intubate the vessel with the guide extension. RESULTS The CrossLiner crossed distally and through a distal stented segment in 8/8 vessels, while the first-generation devices were stuck proximal to the stent (n=2/8) or at the stent edge (n=4/8), or passed partially into the deployed stent with difficulty (2/8) vessels (p < 0.0002 for deliverability). The average depth of guide extension delivery/ "intubation" was 12.9±3.6 cm for the CrossLiner and 5.6±1.1 cm for the first-generation guide extension (p < 0.001). CONCLUSIONS The CrossLiner is a next generation guide extension system that may offer advantages over first generation devices. Further clinical evaluation will be required to assess the role of this new device in PCI.
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Affiliation(s)
- Tim A Fischell
- CrossLiner, Inc., Kalamazoo, MI, United States of America.
| | - Jeffrey Payne
- REV-1 Engineering, Murrieta, CA, United States of America
| | - Kimberly Wehde
- REV-1 Engineering, Murrieta, CA, United States of America
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4
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Chandra S, Tiwari A, Chaudhary G, Yadav R. Guide catheter extension systems: Hype or a need? Indian Heart J 2021; 73:535-538. [PMID: 34627564 PMCID: PMC8514394 DOI: 10.1016/j.ihj.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Guide catheter extension system (GCES) is a valuable tool for interventional cardiologists, especially in complex cases. GCES increases guide back-up support and is crucial in complex PCI procedures, particularly in cases of severe calcification and tortuosity. Apart from their primary use to increase back-up support of guide by providing coaxial alignment, deep intubation and facilitation of stent delivery, GCES are now being increasingly used in different clinical indications including complex and high-risk coronary intervention interventions.
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Affiliation(s)
- Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Ashish Tiwari
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Rakesh Yadav
- Department of Cardiology, AIIMS, New Delhi, India.
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5
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Milford BM, Cohen MG. Coronary Cannulation: Tips for Success in Transradial Angiography and Interventions. Interv Cardiol Clin 2020; 9:21-31. [PMID: 31733738 DOI: 10.1016/j.iccl.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transradial artery access (TRA) is associated with reduced bleeding risk, length of stay, costs, and increased patient satisfaction. Approximately one-third of TRA failures are due to lack of guiding catheter support. Catheter selection and engagement technique are crucial for obtaining good-quality angiograms and successfully completing percutaneous coronary intervention. The maneuvers required for catheter manipulation and coronary engagement differ between TRA and transfemoral arterial access. One of the advantages of TRA is the ability to use a universal catheter, saving time, radiation, and contrast. This review discusses practical learning points to improve operator understanding of catheter selection and coronary engagement technique.
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Affiliation(s)
- Brett M Milford
- Cardiovascular Division, Department of Medicine, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital and Clinics, UHealth Tower, 1400 Northwest 12th Avenue, Suite 864, Miami, FL 33136, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital and Clinics, UHealth Tower, 1400 Northwest 12th Avenue, Suite 864, Miami, FL 33136, USA.
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6
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Kumar P, Aggarwal P, Sinha SK, Khanra D, Razi M, Sharma AK, Thakur R, Pandey U, Krishna V. The Safety and Efficacy of Guidezilla Catheter (Mother-in-Child Catheter) in Complex Coronary Interventions: An Observational Study. Cardiol Res 2019; 10:336-344. [PMID: 31803331 PMCID: PMC6879049 DOI: 10.14740/cr949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/14/2019] [Indexed: 01/02/2023] Open
Abstract
Background Lesion characteristics (anatomy, calcification, tortuosity and angulation), vessel morphology, and lack of support add complexity of coronary intervention. Guidezilla catheter, acting as an extension of guide catheter system (mother-in-child catheter), helps to overcome these complexities by enhancing backup during complex intervention. Methods The present retrospective, single-center study included 13,157 consecutive patients who underwent percutaneous coronary intervention (PCI) through both transfemoral and transradial routes from January 2015 to July 2019 at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India among which Guidezilla™ catheter (Boston Scientific, Natick, MA, USA) was used in 156 patients. Study endpoints were target lesion crossing, procedural success, and complications. The clinical, angiographic and procedural data of all 156 patients were evaluated to assess safety and efficacy of Guidezilla extension catheter (GEC). Results The mean age of the enrolled patients was 61.2 ± 8.67 years. Type-C lesion was commonest (69.9%) followed by B2 (22.4%) and B1 (7.7%). The commonest indication for its use was tortuosity (30.1%) followed by calcification (21.1%), angulation (18.8%), chronic total occlusion (17.9%), distally located lesion (8.3%), and anomalous origin of vessel in 3.8%. The right coronary artery (39.2%) was most commonly intervened artery followed by left anterior descending (LAD) (30.8%), left circumflex (LCX) (19.9%), multivessels (7.6%), and saphenous vein graft in 2.5%. The mean depth of intubation was 4.2 ± 1.9 cm. Mean diameter of stents was 34.2 ± 14.4 mm while mean length of stents was 31.2 ± 10.2 mm. Lesions were modified using aggressive pre-dilatation in 87.8%, followed by cutting balloon in 10.9%. GEC was delivered across the lesion using buddy wire technique (9.6%), balloon-assisted tracking (BAT) in 30.1%, and balloon-assisted sliding and tracking (BLAST) in 4.5% of patients. Stent implantation was successful in 151 out of 156 patients with success rate of 96.7%. Overall failure rate was 3.3% which was contributed by extreme tortuosity, angulation, and severe calcification. Guidezilla-associated procedural complication (dissection, stent dislodgement, shaft breakage) were reported in three patients (1.9%) who were successfully managed. Conclusion s Guidezilla system acting as mother-in-child extension catheter is a safe and effective tool which provides additional backup support and increases success rate of PCI for complex coronary lesions.
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Affiliation(s)
- Prakash Kumar
- Department of Cardiology, Rajendra Institute of Medical Science, Ranchi, Jharkhand, India
| | - Puneet Aggarwal
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | | | - Mahmodullah Razi
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Awdesh Kumar Sharma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
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7
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Chawla R, Ahamad W, Sharma V. Techniques to Overcome Difficulty in Device Deliverability to Lesion in Complex PCI. Curr Cardiol Rev 2019; 16:117-124. [PMID: 31648644 PMCID: PMC7460703 DOI: 10.2174/1573403x15666191018105627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/26/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Raman Chawla
- Department of Cardiology, CAREMAX Superspeciality Hospital, Punjab 144001, India
| | - Wasim Ahamad
- Department of Cardiology, CAREMAX Superspeciality Hospital, Punjab 144001, India
| | - Vivek Sharma
- Department of Cardiology, CAREMAX Superspeciality Hospital, Punjab 144001, India
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 304] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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9
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Kinnaird T, Anderson R, Gallagher S, Cockburn J, Sirker A, Ludman P, de Belder M, Copt S, Nolan J, Zaman A, Mamas M. Vascular Access Site and Outcomes in 58,870 Patients Undergoing Percutaneous Coronary Intervention With a Previous History of Coronary Bypass Surgery: Results From the British Cardiovascular Interventions Society National Database. JACC Cardiovasc Interv 2019. [PMID: 29519382 DOI: 10.1016/j.jcin.2017.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied. BACKGROUND Given the influence of access site on outcomes, use of radial access in PCI-CABG warrants further investigation. METHODS Data were analyzed from 58,870 PCI-CABG procedures performed between 2005 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes. RESULTS The number of PCI-CABG cases and the percentage of total PCI increased significantly during the study period. Femoral artery (FA) utilization fell from 90.8% in 2005 to 57.6% in 2014 (p < 0.001), with no differences in the rate of change of left versus right radial use. In contemporary study years (2012 to 2014), female sex, acute coronary syndrome presentation, chronic total occlusion intervention, and lower operator volume were independently associated with FA access. Length of stay was shortened in the radial cohort. Unadjusted outcomes including an access site complication (1.10% vs. 0.30%; p < 0.001), blood transfusion (0.20% vs. 0.04%; p < 0.001), major bleeding (1.30% vs. 0.40%; p < 0.001), and in-hospital death (1.10% vs. 0.60%; p = 0.001) were more likely to occur with FA access compared with radial access. After adjustment, although arterial complications, transfusion, and major bleeding remained more common with FA use, short- and longer-term mortality and major adverse cardiac event rates were similar. CONCLUSIONS In contemporary practice, FA access remains predominant during PCI-CABG with case complexity associated with it use. FA use was associated with longer length of stay, and higher rates of vascular complications, major bleeding, and transfusion.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Alex Sirker
- Department of Cardiology, University College Hospital, London, United Kingdom
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Mark de Belder
- Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - James Nolan
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
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10
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Vishnevsky A, Savage MP, Fischman DL. GuideLiner™ as guide catheter extension for the unreachable mammary bypass graft. Catheter Cardiovasc Interv 2018. [PMID: 29521472 DOI: 10.1002/ccd.27592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Percutaneous coronary intervention (PCI) of mammary artery bypass grafts through a trans-radial (TR) approach can present unique challenges, including coaxial vessel engagement of the guiding catheter, adequate visualization of the target lesion, sufficient backup support for equipment delivery, and the ability to reach very distal lesions. The GuideLiner catheter, a rapid exchange monorail mother-in-daughter system, facilitates successful interventions in such challenging anatomy. We present a case of a patient undergoing PCI of a right internal mammary artery (RIMA) graft via TR access in whom the graft could not be engaged with any guiding catheter. Using a balloon tracking technique over a guidewire, a GuideLiner was placed as an extension of the guiding catheter and facilitated TR-PCI by overcoming technical challenges associated with difficult anatomy.
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Affiliation(s)
- Alec Vishnevsky
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael P Savage
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David L Fischman
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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11
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Pellicano M, Floré V, Barbato E, De Bruyne B. From debulking to delivery: sequential use of rotational atherectomy and Guidezilla™ for complex saphenous vein grafts intervention. BMC Cardiovasc Disord 2018; 18:122. [PMID: 29921223 PMCID: PMC6006709 DOI: 10.1186/s12872-018-0860-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Percutaneous coronary interventions (PCI) of old calcified saphenous vein grafts (SVGs) is challenging and is associated with a considerably high risk of adverse ischemic events in the short- and long-term as compared to native coronary arteries. We report a case in which a non-dilatable, calcified SVG lesion is successfully treated with rotational atherectomy followed by PCI and stenting with local stent delivery (LSD) technique using the Guidezilla™ guide extension catheter (5-in-6 Fr) in the “child-in-mother” fashion. Case presentation A 70 years-old man with a dilated ischemic cardiomyopathy, triple coronary artery bypass grafting (CABG) in 1990 and chronic renal failure (baseline GFR: 45 ml/min/1.73 m2) underwent a coronary angiography for a Non-ST segment elevation myocardial infarction (NSTEMI). Native coronary circulation was completely occluded at the proximal segments. Grafts angiography showed a tandem calcified lesions of SVG on distal right coronary artery (RCA) and an ostial stenosis of the SVG on first obtuse marginal branch (OM1). Left internal mammary artery on the mid left anterior descending artery was patent. Ad Hoc PCI of SVG on RCA was attempted. The proximal calcified stenosis has been crossed with a 1.5 x 12 mm balloon only with the support of Guidezilla™, however the non-compliant (NC) balloon 2.5 x 15 mm was unable to break the hard and calcified plaque. After several attempts, the procedure was interrupted with a suboptimal result. An elective transradial PCI of SVG on RCA with rotational atherectomy was performed. Two runs with 1.25 mm burr and 2 runs with 1.5 mm burr were carried out. Then, the use of distal anchoring balloon warranted support and tracking, made as centring rail for the advance of the tip of the “mother-and-child” catheter into the SVG. During slow deflation of the balloon, the Guidezilla™ was advanced distal to the stenoses to be stented, thus allowing the placement of two long drug eluting stents according to a LSD technique. Conclusions Rotational atherectomy is a feasible option for non-dilatable stenoses in old SVGs when there is no evidence of thrombus or vessel dissection and the subsequent use of “mother-and-child” catheter has a key role, especially in case of radial approach, for long stents delivery.
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Affiliation(s)
- Mariano Pellicano
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, B 9300, Aalst, Belgium. .,Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy.
| | - Vincent Floré
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, B 9300, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, B 9300, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, B 9300, Aalst, Belgium
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12
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Ma M, Diao KY, Liu XJ, He Y. Early clinical experience with Guidezilla for transradial interventions in China. Sci Rep 2018; 8:5444. [PMID: 29615647 PMCID: PMC5882861 DOI: 10.1038/s41598-018-23633-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/16/2018] [Indexed: 02/05/2023] Open
Abstract
Anatomic variations, calcified, tortuous, angulated lesions, and lack of support to increase the complexity of transradial intervention (TRI). Guidezilla is a mother-and-child catheter enabling increased support during complex interventions. As there are few published reports of its use, we describe our experience using this device to assist TRI in Chinese patients. The aim of this study was to investigate the efficacy and safety of the Guidezilla guide extension catheter in complex coronary interventions. Thirty-two patients’ clinical characteristics, angiographic details, and in-hospital outcome retrospectively collected between June 2015 and August 2017. Patients were 59.44 ± 10.48 years of age and 26 (81%) were men. The most frequent target vessels were the RCA (34%) and LAD (31%), patients had complex type C (53%) or B (47%) lesions, severely tortuous (41%) and angulated (22%).With the use of Guidezilla, technique success was 100%, and procedural success was 94%. The mean diameter of the deployed stents was 2.97 ± 0.37 mm, and the length was 27.19 ± 8.14 mm. The estimated mean distance of Guidezilla intubation into the target vessel was 7.66 ± 2.29 cm.The Guidezilla catheter extension safely facilitated successful completion of TRI in complex coronary artery lesions. This device can help interventionalists successfully perform difficult procedures.
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Affiliation(s)
- Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu, 610041, China.,Department of Cardiology, the Sixth People's Hospital of Chengdu, Chengdu, 610051, China
| | - Kai-Yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Jing Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu, 610041, China.,Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu, 610041, China.
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13
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Ma J, Hou L, Qian J, Ge L, Zhang F, Chang S, Xu R, Qin Q, Ge J. The safety and feasibility of guidezilla catheter in complex coronary interventions and an observational study. Medicine (Baltimore) 2017; 96:e8172. [PMID: 28984768 PMCID: PMC5738004 DOI: 10.1097/md.0000000000008172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The monorail Guidezilla guide extension catheter was designed to provide additional backup and facilitate device delivery in percutaneous coronary intervention (PCI) for complex coronary anatomy such as chronic total occlusion (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries, among others.The present retrospective, single-center study included 188 consecutive patients who underwent PCI using the Guidezilla catheter from March 2015 to August 2016. Study outcomes were rates of target lesion crossing success, procedural success, and complications.The Guidezilla catheter was used most commonly in PCI of CTOs (45%) and heavy proximal calcification (37%), followed by tortuosity (10%), previously deployed proximal stents (4%), and coronary artery anomaly (4%). The right coronary artery (48%) was most commonly intervened followed by the left ascending (35%) and left circumflex (17%) arteries. Rates of target lesion crossing success and procedural success were both 99%, with one device-related periprocedural complication, namely proximal vessel dissection secondary to deep insertion which was successfully treated with stent implantation. Ninety percent of PCI were performed and completed successfully by radial access.In a single center with experienced operators, the use of the Guidezilla guide extension catheter in PCI of complex coronary anatomy performed mostly via radial artery access appeared safe and efficacious, and greatly facilitated device delivery.
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14
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Guelker JE, Blockhaus C, Kroeger K, Wehner R, Klues H, Bufe A. The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion. J Saudi Heart Assoc 2017; 30:69-74. [PMID: 29910576 PMCID: PMC6000889 DOI: 10.1016/j.jsha.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 11/30/2022] Open
Abstract
Background Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use. Methods We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. Results Almost all lesions were classified as severely calcified (94.4 ± 0.24%). The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications. Conclusions The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible.
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Affiliation(s)
- Jan-Erik Guelker
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Christian Blockhaus
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Knut Kroeger
- Department of Vascular medicine, Helios Clinic Krefeld, Krefeld, GermanycGermany
| | - Rosemarie Wehner
- RWI - Leibniz-Institute for Economic Research, Essen, GermanyeGermany
| | - Heinrich Klues
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany
| | - Alexander Bufe
- Hertcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyaGermany.,Institute of Heart and Circulation Research, University of Cologne, Cologne, GermanybGermany.,University of Witten-Herdecke, Witten, GermanydGermany
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15
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Gilchrist IC, Awuor SO, Davies RE, Ukaigwe AC. Controversies in complex percutaneous coronary intervention: radial versus femoral. Expert Rev Cardiovasc Ther 2017; 15:695-704. [PMID: 28730857 DOI: 10.1080/14779072.2017.1358613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Evolution in the technology used in the cardiac catheterization laboratory has permitted a migration from the femoral to radial artery access for many interventional procedures while concurrently improving outcomes. As a disruptive technology, transradial access has been associated with several controversies including a dichotomous relationship with femoral access. Areas covered: Several different patient subsets along with perceived technical challenges in interventional cardiology are reviewed with regard to the issue of access site. Evolving technological improvements germane to transradial techniques are also discussed as garnered from the literature of recent clinical trials and reports. Expert commentary: Radial techniques have been enhanced by newer technology and the spread of knowledge. Fusion of radial techniques with those of the femoral approach is evolving into a unifying concept of using the access that is most appropriate for the patient. No one access technique can cover all clinical subsets of patients. There is a need for complimentary access skillsets for even the most advanced cardiovascular technology used in the cardiac catheterization laboratory if the patients' outcomes are to be idealized.
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Affiliation(s)
- Ian C Gilchrist
- a College of Medicine, Heart & Vascular Institute, M.S. Hershey Medical Center , Pennsylvania State University , Hershey , PA , USA
| | - Stephen O Awuor
- a College of Medicine, Heart & Vascular Institute, M.S. Hershey Medical Center , Pennsylvania State University , Hershey , PA , USA
| | - Rhian E Davies
- a College of Medicine, Heart & Vascular Institute, M.S. Hershey Medical Center , Pennsylvania State University , Hershey , PA , USA
| | - Anene C Ukaigwe
- a College of Medicine, Heart & Vascular Institute, M.S. Hershey Medical Center , Pennsylvania State University , Hershey , PA , USA
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16
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Koutouzis M, Karatasakis A, Brilakis ES, Agelaki M, Maniotis C, Dimitriou P, Lazaris E. Feasibility and safety of same-day discharge after complex percutaneous coronary intervention using forearm approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:245-249. [DOI: 10.1016/j.carrev.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
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17
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Ichimoto E, De Gregorio J. Successful deployment of polytetrafluoroethylene-covered stent to seal left internal mammary artery graft perforation due to guide catheter extension system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:574-577. [DOI: 10.1016/j.carrev.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/17/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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18
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Sharma D, Shah A, Osten M, Ing D, Barolet A, Overgaard CB, Džavík V, Seidelin PH. Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention. J Interv Cardiol 2016; 30:46-55. [PMID: 27862338 DOI: 10.1111/joic.12354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Divyesh Sharma
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashish Shah
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark Osten
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Ing
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alan Barolet
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter H Seidelin
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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19
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Guide extension catheter stepwise advancement facilitated by repeated distal balloon anchoring. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:66-69. [PMID: 27638104 DOI: 10.1016/j.carrev.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
Coronary stent delivery can be extremely challenging in tortuous and calcified lesions especially when radial approach is chosen. Guide extension catheter is a useful tool for overcoming the inherent difficulties arising by the use of radial access in complex percutaneous interventions. We describe a technique for guide extension catheter system advancement by presenting two cases. This was performed stepwise by repeated distal balloon anchoring in the coronary artery of interest.
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20
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Chan PH, Alegria-Barrero E, Foin N, Paulo M, Lindsay AC, Viceconte N, Di Mario C. Extended use of the GuideLiner in complex coronary interventions. EUROINTERVENTION 2016; 11:325-35. [PMID: 24930135 DOI: 10.4244/eijy14m06_02] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Challenging coronary anatomies including chronic total occlusions (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries pose difficulties in coronary interventions. The GuideLiner is a monorail catheter originally developed to facilitate delivery of stents to target lesions in tortuous vessels. We conducted a study on the feasibility and safety of utilising this catheter in a wider array of complex coronary interventions. METHODS AND RESULTS Consecutive patients undergoing coronary or peripheral interventions where a GuideLiner was used were recruited into this study. Patient demographics, lesion and vessel characteristics, procedural details and outcomes were prospectively entered into our database and analysed. From September 2009 to October 2011, 54 consecutive patients underwent coronary intervention in our institution using a GuideLiner; 21 out of 54 coronary applications were motivated by the need to increase support to cross CTOs, predominantly of the RCA. Anomalous or angulated take-off of the treatment vessels (31%), previously deployed proximal stents (15%), heavy proximal calcification (9%) and tortuosity (7%) accounted for the remaining reasons. One patient had successful renal denervation with the aid of a GuideLiner catheter. Procedural success was 98% in our series with no device-related periprocedural complications such as ostial dissection or myocardial necrosis. CONCLUSIONS The use of a GuideLiner facilitates the approach to complex coronary interventions including chronic total occlusion and saphenous vein graft intervention by providing greater back-up support and easier engagement of coronary ostia.
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Affiliation(s)
- Pak Hei Chan
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
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21
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Fabris E, Kennedy MW, Di Mario C, Sinagra G, Roolvink V, Ottervanger JP, Van't Hof AWJ, Kedhi E. Guide extension, unmissable tool in the armamentarium of modern interventional cardiology. A comprehensive review. Int J Cardiol 2016; 222:141-147. [PMID: 27494727 DOI: 10.1016/j.ijcard.2016.07.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Enrico Fabris
- ISALA Hartcentrum, Zwolle, The Netherlands; Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Carlo Di Mario
- Royal Brompton Hospital & NHLI Imperial College, London, United Kingdom
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
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22
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Citius, Altius, Fortius: The impact of guide catheter extensions in contemporary percutaneous coronary intervention. Anatol J Cardiol 2016; 16:340-1. [PMID: 27240607 DOI: 10.14744/anatoljcardiol.2016.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Dursun H, Taştan A, Tanrıverdi Z, Özel E, Kaya D. GuideLiner catheter application in complex coronary lesions: experience of two centers. Anatol J Cardiol 2016; 16:333-9. [PMID: 26168458 PMCID: PMC5336781 DOI: 10.5152/anatoljcardiol.2015.6214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Hüseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir-Turkey.
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24
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Farooq V, Serruys PW, Mustafa AH, Mamas MA, Malik N, Alhous HA, El-Omar M, Hendry C, Rana DN, Shelton D, Wright PK, Narine N, Clarke B, Keavney B, Fath-Ordoubadi F, Fraser DG. Forward and back aspiration during ST-elevation myocardial infarction: a feasibility study. EUROINTERVENTION 2016; 11:e1639-48. [DOI: 10.4244/eijv11i14a315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Waterbury TM, Sorajja P, Bell MR, Lennon RJ, Mathew V, Singh M, Sandhu GS, Gulati R. Experience and complications associated with use of guide extension catheters in percutaneous coronary intervention. Catheter Cardiovasc Interv 2015; 88:1057-1065. [DOI: 10.1002/ccd.26329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/24/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas M. Waterbury
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern; Minneapolis Minnesota
| | - Malcolm R. Bell
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Verghese Mathew
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Mandeep Singh
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Gurpreet S. Sandhu
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Rajiv Gulati
- Division of Cardiovascular Diseases; Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
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26
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Alfonso CE, Cohen MG. Diagnostic and Guide Catheter Selection and Manipulation for Radial Approach. Interv Cardiol Clin 2015; 4:145-159. [PMID: 28582046 DOI: 10.1016/j.iccl.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transradial catheterization and percutaneous coronary interventions have multiple advantages, including reduced bleeding risk, reduced length of stay and costs, and increased patient comfort. Transradial catheterization and interventions requires the acquisition of various additional skill sets including radial arterial puncture, the ability to navigate the upper extremity vasculature, and understanding catheter selection and coronary engagement technique. Although standard femoral catheter shapes perform adequately from the left or right radial approach for coronary angiography, for percutaneous coronary intervention guide catheter support is critical. This article summarizes some practical learning points pertaining to navigating the upper extremity vasculature, and understanding catheter selection and coronary engagement technique.
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Affiliation(s)
- Carlos E Alfonso
- Cardiac Catheterization Laboratory, Cardiovascular Division, Department of Medicine, University of Miami Hospital, University of Miami Miller School of Medicine, 1400 Northwest 12th Avenue, Miami, FL 33136, USA
| | - Mauricio G Cohen
- Cardiac Catheterization Laboratory, Cardiovascular Division, Department of Medicine, University of Miami Hospital, University of Miami Miller School of Medicine, 1400 Northwest 12th Avenue, Miami, FL 33136, USA.
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27
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Farooq V, Fraser DG, El-Omar M, Mamas MA, Clarke B, Fath-Ordoubadi F. Lessons from acute and late scaffold failures in the ABSORB EXTEND trial: have we really learned them all? EUROINTERVENTION 2014; 10:419-23. [DOI: 10.4244/eijv10i4a73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Brilakis ES, Lee M, Mehilli J, Marmagkiolis K, Rodes-Cabau J, Sachdeva R, Kotsia A, Christopoulos G, Rangan BV, Mohammed A, Banerjee S. Saphenous Vein Graft Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:301. [DOI: 10.1007/s11936-014-0301-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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29
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Derraz Y, Benamer H, Lefèvre T, Chevalier B, Hovasse T, Chaito R, Garot P, Morice MC, Louvard Y. [The use of the Five-in-Six System for stent delivery in challenging coronary lesions: a multi-center experience]. Ann Cardiol Angeiol (Paris) 2013; 62:392-7. [PMID: 24182850 DOI: 10.1016/j.ancard.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The mother and child "5-in-6" technique using the Heartrail II catheter is a novel tool allowing stent delivery in challenging lesions, when conventional techniques have failed. METHODS A total of 147 consecutive patients underwent percutaneous coronary intervention (PCI) using the "5-in-6" Heartrail II catheter was restrospectively identified in the Institut Cardiovasculaire Paris Sud, (Jacques-cartier hospital), Institut hospitalier Claude-Galien (Claude-Galien hospital) and European hospital of Paris between July 2009 and September 2012. RESULTS Ten interventional cardiologists treated 147 patients with the new device. The patients mean age was 68.5 ± 21.5 years, 78% were men. Radial access was used in 128 cases (87.9%). The treated vessels were the right coronary artery in 82%, left anterior descending in 22%, left circumflex in 18%, marginal branch in 9%, the posterior descending artery in three patients, retroventricular artery in one patient and a saphenous graft in two patients. Most lesions (70%) had American Heart Association/American College of Cardiology (AHA/ACC) type B2 or C, and greater than 50% were located in distal vessel segments. Mean lesion length was 16 ± 4 mm, which is indicative of long lesion. Most (62%) lesions were moderately to heavily calcified and 22 (14%) were chronic total occlusions. Problems with stent delivery were due to poor guide catheter support or excessive calcification. Introduction of the "Heartrail II" catheter allowed successful stent delivery in 139 cases (94%). CONCLUSION The "5 in 6" Heartrail II catheter is a simple and easy-to-use device that can improve the success of stent delivery in challenging coronary interventions.
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Affiliation(s)
- Y Derraz
- Hôpital européen La Roseraie, Paris, France.
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30
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Eddin MJ, Armstrong EJ, Javed U, Rogers JH. Transradial interventions with the GuideLiner catheter: role of proximal vessel angulation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:275-9. [PMID: 23972538 DOI: 10.1016/j.carrev.2013.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/03/2013] [Accepted: 07/11/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transradial coronary intervention (TRI) is increasingly common, but anatomic variations and lack of guide catheter support may increase the complexity of TRI. The GuideLiner catheter (Vascular Solutions, Minneapolis,MN) is a guide catheter extension developed to provide increased guide catheter support. We hypothesized that TRI cases requiring GuideLiner support would have a greater proximal vessel angle and increased lesion angle tortuosity. METHODS This was a retrospective study reviewing 146 TRI cases performed at a single institution between August 2010 and June 2012. 22 cases (15%) required use of the GuideLiner support catheter. Procedural and angiographic characteristics of all cases were analyzed. Multivariable analysis and receiver operator curves (ROC) were used to analyze predictors of GuideLiner use. RESULTS The indications for TRI were similar between both groups. Subjects who required use of the GuideLiner support catheter at the time of TRI were significantly older (69±12years vs. 62±13years, p=0.03). The proximal vessel angle was significantly greater in the cases requiring GuideLiner support (74°±35° vs. 37°±23°, p<0.001). Lesion angle in the Guideliner group was also significantly greater (48°±32° vs. 28°±25°, p<0.001). On multivariable analysis, proximal vessel angle independently predicted the need for GuideLiner support (AOR 1.4 per 10°, p<0.001). A 45° proximal vessel angle predicted the need for GuideLiner use with a sensitivity of 73% and specificity of 74% (c-statistic 0.79). None of the Guideliner TRI cases required conversion to femoral access. CONCLUSIONS TRIs requiring GuideLiner catheter support had significantly increased lesion complexity and vessel tortuosity. Proximal vessel angulation is significantly associated with the need for GuideLiner use during transradial intervention. Use of the Guideliner facilitated successful completion of PCI despite the use of a wide variety of guiding catheters in this series.
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Affiliation(s)
- Moneer J Eddin
- University of California, Davis Medical Center, Division of Cardiovascular Medicine, Sacramento, CA
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31
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Farooq V, Serruys PW, Bourantas CV, Zhang Y, Muramatsu T, Feldman T, Holmes DR, Mack M, Morice MC, Ståhle E, Colombo A, de Vries T, Morel MA, Dawkins KD, Kappetein AP, Mohr FW. Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial Validation of the Residual SYNTAX Score. Circulation 2013; 128:141-51. [DOI: 10.1161/circulationaha.113.001803] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background—
The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI).
Methods and Results—
In the randomized PCI cohort of the SYNTAX Trial (n=903), the baseline and residual SYNTAX Scores were calculated. Subjects with a residual SYNTAX Score of 0 were defined as having undergone complete revascularization (CR), and a residual SYNTAX Score >0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual SYNTAX Score: >0–4, >4–8, and >8). In the PCI cohort, the mean baseline and residual SYNTAX Scores were 28.4±11.5 and 4.5±6.9, respectively. The mean Δ SYNTAX Score (representative of the burden of disease removed by PCI) was 23.8±10.9. The residual SYNTAX Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, >0 to 4 (n=184, 20.4%), >4 to 8 (n=167, 18.5%), >8 (n=153, 16.9%). A progressively higher residual SYNTAX Score was shown to be a surrogate marker of increasing clinical comorbidity and anatomic complexity. Subjects with CR or residual SYNTAX Scores ≤8 had comparable 5-year mortality (CR, 8.5%; residual SYNTAX Score >0–4, 8.7%; >4–8, 11.4%;
P
=0.60). A residual SYNTAX Score >8 was associated with 35.3% all-cause mortality at 5-years (
P
<0.001). Stratified analyses in the predefined medical treated diabetic and left main subgroups yielded similar results.
Conclusions—
The residual SYNTAX Score was shown to be a powerful indicator of 5-year mortality in the SYNTAX Trial. The residual SYNTAX Score may aid in determining a reasonable level of revascularization.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00114972.
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Affiliation(s)
- Vasim Farooq
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Patrick W. Serruys
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Christos V. Bourantas
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Yaojun Zhang
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Takashi Muramatsu
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Ted Feldman
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - David R. Holmes
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Michael Mack
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Marie Claude Morice
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Elisabeth Ståhle
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Antonio Colombo
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Ton de Vries
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Marie-angèle Morel
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Keith D. Dawkins
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Arie-Pieter Kappetein
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
| | - Friedrich W. Mohr
- From the Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands (V.F., P.W.S., C.V.B., Y.Z., T.M.); Evanston Hospital, Evanston, IL (T.F.); The Mayo Clinic, Rochester, MN (D.R.H.); Medical City Dallas Hospital, Dallas, TX (M.M.); Institut Jacques Cartier, Massy, France (M.C.M.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milano, Italy (A.C.); Cardialysis BV, Rotterdam, The Netherlands (T.d.V.,
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Chang YC, Fang HY, Chen TH, Wu CJ. Left main coronary artery bidirectional dissection caused by ejection of guideliner catheter from the guiding catheter. Catheter Cardiovasc Interv 2013; 82:E215-20. [PMID: 23413132 DOI: 10.1002/ccd.24864] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 11/13/2012] [Accepted: 02/09/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Yi-Chih Chang
- Division of Cardiology; Xiamen Chang Gung Hospital; China
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cockburn J, Poliacikova P, Hildick-Smith D, Colombo A, Buchanan GL, von Birgelen C. How should I treat a patient with significant angina and a severe left anterior descending artery stenosis beyond the insertion of a left internal mammary artery jump graft (diagonal to LAD)? EUROINTERVENTION 2012; 8:400-7. [PMID: 22829513 DOI: 10.4244/eijv8i3a60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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de Man FHAF, Tandjung K, Hartmann M, van Houwelingen KG, Stoel MG, Louwerenburg HW, Basalus MWZ, Sen H, Löwik MM, von Birgelen C. Usefulness and safety of the GuideLiner catheter to enhance intubation and support of guide catheters: insights from the Twente GuideLiner registry. EUROINTERVENTION 2012; 8:336-44. [PMID: 22829509 DOI: 10.4244/eijv8i3a52] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Optimal ostial seating and adequate back-up of guide catheters are required for challenging percutaneous coronary interventions (PCI). The GuideLiner™ (GL) (Vascular Solutions Inc., Minneapolis, MN, USA) is a guide catheter extension system that provides active back-up support by deep coronary intubation. We aimed to assess feasibility and safety of GL-use in routine clinical practice. METHODS AND RESULTS We prospectively recorded patient and procedural details, technical success, and in-hospital outcome of 65 consecutive patients undergoing "5-in-6" Fr GL-facilitated PCI of 70 target vessels. The GL was mainly used for PCI of complex coronary lesions: 97% (68/70) had American Heart Association/American College of Cardiology (AHA/ACC) lesion types B2/C; 53% (37/70) were distally located; and 23% (17/70) were heavily calcified. Indications were to increase back-up of the guide and facilitate stent delivery (59%; 41/70), achievement of coaxial alignment of the guide catheter (29%; 20/70), and selective contrast injections (13%; 9/70). Device success rate was 93% (65/70). There were no major complications and two minor complications managed without clinical sequelae: one air embolism and one stent dislodgement. CONCLUSIONS GL-use resulted in increased back-up and guide catheter alignment for stent delivery in unfavourable tortuous coronary anatomies and complex, heavily calcified, and often distally located lesions, which otherwise may have been considered unsuitable for PCI. Procedural success rate was high and there were no major complications.
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Affiliation(s)
- Frits H A F de Man
- Department of Cardiology, Thoraxcentrum Twente, Haaksbergerstraat 55, Enschede, The Netherlands
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Luna M, Papayannis A, Holper EM, Banerjee S, Brilakis ES. Transfemoral use of the guideLiner catheter in complex coronary and bypass graft interventions. Catheter Cardiovasc Interv 2011; 80:437-46. [DOI: 10.1002/ccd.23232] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/16/2011] [Accepted: 05/02/2011] [Indexed: 11/09/2022]
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Michael TT, Brilakis ES. Taming saphenous vein grafts using guide catheter extensions. Catheter Cardiovasc Interv 2011; 78:864-5. [PMID: 22086775 DOI: 10.1002/ccd.23411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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COLA CLARISSA, MIRANDA FAUSTINO, VAQUERIZO BEATRIZ, FANTUZZI ANDRES, BRUGUERA JORDI. The Guideliner™ Catheter for Stent Delivery in Difficult Cases: Tips and Tricks. J Interv Cardiol 2011; 24:450-61. [DOI: 10.1111/j.1540-8183.2011.00671.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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