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

Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions

BACKGROUND

Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications.

AIM

Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use.

RESULTS

From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J-CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78-2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41-2.41, p = 0.986), in-hospital death (OR: 1.39, 95% CI: 0.54-3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52-2.19, p = 0.850) were similar in both groups.

CONCLUSION

In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

Efficacy and safety of guide extension catheter in balloon pulmonary angioplasty for treatment of complex lesions in chronic thromboembolic pulmonary hypertension

BACKGROUND

Balloon pulmonary angioplasty (BPA) is used for treatment of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and residual pulmonary hypertension after pulmonary endarterectomy (PEA) to improve hemodynamics, right ventricular function, and exercise capacity. However, the effectiveness and safety of guide extension catheters for BPA treatment in patients with CTEPH have not been demonstrated.

METHODS

We retrospectively analyzed 91 lesions in 55 sessions of 28 patients with CTEPH who underwent BPA using a guide extension catheter. The purpose (backup, coaxial, and extension), efficacy, and safety of the guide extension catheters were explored. The efficacy of the guide extension catheter was assessed based on the success of the procedures and safety was evaluated based on procedure-related complications.

RESULTS

Regarding the intended use, a guide extension catheter was used to strengthen the backup force of the guiding catheter in 52% of cases, extend the tip of the catheter in 38% of cases, and maintain the coaxiality of the guiding catheter in 10% of cases. Procedural success was achieved in 92.7% of 55 sessions and in 95.6% of 91 lesions. Complex lesions had a lower success rate than simple lesions (p = 0.04). Regarding safety concerns, complications were observed in 5 of 55 sessions (9.1%) and 6 of 91 lesions (6.6%). Only one case of pulmonary artery dissection using a guide extension catheter was reported. Except for this one case, extension catheter-related complications were not observed.

CONCLUSIONS

A guide extension catheter can be used safely in BPA procedures with anatomically complex pulmonary artery branches and complex lesions by increasing backup support.

A Next-Generation Guide Extension System for Percutaneous Coronary Intervention

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.

Application of a rapid exchange extension catheter technique in type B2/C nonocclusive coronary intervention via a transradial approach

BACKGROUND

In transradial intervention procedures, poor back-up support and noncoaxial alignment of the guide catheter (GC) may result in failure of the balloon or stent to reach the targeted lesion. Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications. A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.

AIM

To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.

METHODS

A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study. The clinical characteristics, indications for use of the rapid exchange extension catheter, and procedural details and results were reviewed and analyzed. All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.

RESULTS

The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity (37.8%), followed by heavy calcification (28.9%), long lesions (20.0%), proximal stent (6.7%), in-stent restenosis (5.2%), and coronary origin anomalies (1.5%). The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter: Multiple predilatation technique (57%), buddy wire technique (33.4%), balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extension catheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheter service time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5 ± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success (balloon or stent successful crossing of the target lesion with this technique) was 94.8%.

CONCLUSION

The rapid exchange extension catheter technique showed acceptable safety and efficacy in the transradial coronary interventions of type B2/C nonocclusive coronary lesions. We recommend this technique to assist in complex lesion intervention via radial access.

When Things Get Stuck: Gear Entrapment and Other Complications of Chronic Total Occlusion Percutaneous Coronary Intervention

Complex coronary artery intervention stresses the limits of both the operator's skills as well as the equipment being used for the procedure. This article is focused on avoiding, recognizing and dealing with device failure and gear entrapment during complex coronary intervention. The operator must understand how to avoid these complications by understanding the limits of devices and the need for adequate vessel preparation. This article focuses on giving the reader an algorithmic approach to recognizing when device failure/entrapment occurs and what specific maneuvers can be done to retrieve different devices and equipment safely.

Feasibility of kissing balloon technique through guide extension catheters: an experimental bench test

Previous reports showed that GuideLiner (GL) and Guidezilla (GZ) can accommodate bulky and multiple devices beyond the official profiles. However, feasibility of kissing balloon technique (KBT) through these devices is unknown. The tested devices included 7Fr-GL/GZ and respective three types of 2.5 mm semi-compliant (SC) and non-compliant (NC) balloons: conventional model (CM), tapered-tip model (TM) and latest model (LM). First, three experienced operators attempted to advance all 21 combinations of the 2 balloons through GL/GZ on the guidewires and assessed the crossability in 3 grades: easy, difficult and impossible. Second, the only balloon combinations graded as easy by all operators were tested in the polyurethane-made bifurcation model which required KBT following cross-over stenting. Within the total of 42 device combinations, only one balloon combination of double LM-NC balloons was classified as easy in both GL/GZ by consensus opinion of the operators. While two combinations of LM-SC and LM-SC/NC balloons were classified as difficult in both GL/GZ, all four combinations of LM-SC/NC and CM/TM-NC balloons were classified as difficult only in GL. Other 32 combinations were all classified as impossible. In the bifurcation model, the combination of double LM-NC balloons using GL achieved KBT while the same balloon combination with GZ failed. The feasibility of KBT using child-catheter is highly dependent on the device characteristics. The combination of latest small-profile NC balloons through GL could be clinically applicable.

Patient outcomes in GuideLiner facilitated percutaneous coronary intervention stratified by the SYNTAX score: A retrospective analysis

Objectives

To determine patient outcomes in GuideLiner facilitated percutaneous coronary intervention stratified by the SYNTAX score.

Design

Single centre retrospective cohort analysis.

Participants

A total of 540 consecutive cases facilitated by GuideLiner at a single center.

Main outcome measures

Successful stent delivery, in-hospital, 30 day and 1 year mortality rates stratified by SYNTAX score.

Results

The most common indication for GuideLiner was need for increased support for balloon or stent delivery (82%), 6% for non-coaxial guide, 9% for chronic total occlusion and 3% for selective vessel engagement. Successful stent delivery was achieved in 91% of all cases, with no complications occurred due to GuideLiner use. In-hospital, 30 day and 1 year mortality rates were 2.8%, 2.1% and 4.5%, respectively. The high SYNTAX group was associated with higher rates of initial TIMI score of 0–1; however, the final TIMI score rate of successful delivery and complications did not differ between groups. In-hospital and 1 year mortality rates were higher in the higher SYNTAX groups.

Conclusions

The GuideLiner is an easy to use guide catheter extension system with high rates of success and low rates of complications, across all SYNTAX groups.

Adverse Events Associated with the Use of Guide Extension Catheters during Percutaneous Coronary Intervention: Reports from the Manufacturer and User Facility Device Experience (MAUDE) database

BACKGROUND/PURPOSE

We aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters.

METHODS/MATERIALS

The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events.

RESULTS

Of the 65 cases with reported GuideLiner-related issues, 15 (23%) involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the GuideLiner catheter, 38 (58%) involved GuideLiner catheter fracture, 9 (14%) involved coronary artery dissection, 2 (3%) involved coronary artery perforation, and 1 (1.5%) involved thrombus formation in the catheter. Of the 408 cases with reported Guidezilla-related issues, 53 (13%) involved inability to pass or damaged PCI devices into the Guidezilla catheter, 117 (29%) involved inability to advance the Guidezilla catheter to the target lesion, 59 (14%) involved kinked Guidezilla catheter, mostly because of partial or complete catheter fracture upon further investigation, 164 (40%) involved a broken Guidezilla catheter, 10 (2.5%) involved coronary artery dissection, 2 (0.5%) involved coronary artery perforation, 1 (0.2%)involved aortic dissection, 1 (0.2%) involved thrombosis formation, and 1 (0.2%) involved no-reflow phenomenon.

CONCLUSIONS

Findings from the MAUDE database highlight the complications and modes of events associated with the use of GuideLiner and Guidezilla extension catheters.

SUMMARY

To assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters, the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried. There were more reports on Guidezilla-related events during the search period. The events for both extension catheters mainly involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the extension catheter, extension catheter fracture, coronary artery dissection and perforation and, occasionally, the death of the patients.

Comparison of the device performance between the conventional guide extension catheter and the soft guide extension catheter

BACKGROUND

The guide extension catheter is frequently used in current percutaneous coronary intervention, and the GuideLiner (Vascular Solutions Inc., Minneapolis, MN) has been the standard guide extension catheter. Recently, the Guideplus (Nipro, Osaka, Japan) has emerged as a new guide extension catheter. The aim of the present study was to compare device performance between the Guideplus and GuideLiner.

METHODS

We compared the purpose of guide extension catheter and the device unsuccessful rate between the Guideplus and GuideLiner. We classified the purpose of guide extension catheter into 4 categories: (1) to advance devices into the target lesion, (2) to engage guide catheter into the ostium, (3) to support the small profile balloon crossing the CTO or 99% stenosis that the microcatheter could not cross, and (4) others.

RESULTS

Ninety-two lesions were classified as the Guideplus group, whereas 103 lesions were classified as the GuideLiner group. The purpose of guide extension catheter was significantly different between the 2 groups (P < 0.001). The Guideplus was frequently used to support the small profile balloon crossing the CTO or 99% stenosis (20.7%), whereas the GuideLiner was not used (0%). The device unsuccessful rate was significantly less in the Guideplus (8.7%) than in the GuideLiner (20.4%) (P = 0.022).

CONCLUSIONS

The purpose of guide extension catheter was significantly different between the Guideplus and GuideLiner. The Guideplus was more frequently used to support the small profile balloon crossing the CTO or 99% stenosis. The device unsuccessful rate was less in the Guideplus, which may suggest the better performance as the guide extension catheter.

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.

Common themes in patients requiring urgent cardiothoracic surgery after percutaneous coronary interventions: Case series and review of the literature

Urgent cardiothoracic surgical intervention for the management of complications of percutaneous coronary intervention is uncommon in the stent era. Nonetheless, given increasing procedural complexity, in part reflecting an aging population, an ongoing hazard for urgent surgery remains. We sought to review the incidence and outcome of urgent cardiothoracic surgery in patients undergoing PCI in a contemporary cohort at a tertiary referral centre. The incidence of cardiothoracic intervention for PCI related complications was low at 0.1% over a ten-year period, with iatrogenic coronary artery and aortic root dissection unable to successfully managed percutaneously recurrent precipitants for surgical involvement. Procedural features associated with the need for urgent surgery are noted and methods to overcome such complications discussed.