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Poommipanit P, Tashtish N. The utility of guide catheter extensions (GCE) in coronary interventions and specifically chronic total occlusion (CTO) interventions. Catheter Cardiovasc Interv 2024; 103:823. [PMID: 38488194 DOI: 10.1002/ccd.31012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
Key points
Guide catheter extensions (GCE) are associated with improved success in chronic total occlusions interventions.
GCE can be associated with a higher risk of complications, although found to not be statistically significant in this large multicenter registry.
Care must be exercised in the use of GCE to ensure a successful intervention and limit rates of complications.
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Affiliation(s)
- Paul Poommipanit
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, USA
| | - Nour Tashtish
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, USA
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Filho EM, Araujo GN, Machado GP, Padilla L, de Paula JET, Botelho AC, Campos CM, Quesada FLH, Alcantara M, Santiago R, de Los Santos FD, Oliveira MD, Ribeiro MH, Perez L, Pinto ME, Côrtes LA, Piccaro P, Brilakis ES, Quadros AS. Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions. Catheter Cardiovasc Interv 2024; 103:539-547. [PMID: 38431912 DOI: 10.1002/ccd.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/25/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
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.
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Affiliation(s)
| | - Gustavo N Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Instituto de Cardiologia de Santa Catarina, São José, Brazil
| | | | - Lucio Padilla
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Félix D de Los Santos
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Centro Medico ABC, Mexico City, Mexico
| | - Marcos D Oliveira
- Hospital São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marcelo H Ribeiro
- Imperial Hospital de Caridade, Florianópolis, Brazil
- Hospital SOS Cardio, Florianópolis, Brazil
| | - Luiz Perez
- Hospital Clinico Regional Dr Guillermo Grant Benavente, Concepcion, Chile
| | | | | | - Pedro Piccaro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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Tanaka K, Okamura A, Kameda S, Iwamoto M, Watanabe S, Kashiyama T, Sumiyoshi A, Tanaka T, Kawahira M, Tanaka N, Koyama Y, Watanabe H, Iwakura K. Guide extension proximal locking method: standardization of maximum backup force in percutaneous coronary intervention. Cardiovasc Interv Ther 2023; 38:395-405. [PMID: 37184629 DOI: 10.1007/s12928-023-00936-9] [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] [Received: 12/27/2022] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
We developed the smallest diameter guide-extension catheter (GUIDE PLUS® 5Fr) to enable a new technique, the guide-extension proximal locking method (GP-Lock), and assessed its efficacy in the present experimental and clinical study. Sufficient guide catheter backup is sometimes crucial for PCI. We developed the KIWAMI-Lock direct anchoring method to obtain the strongest backup force by locking a Kiwami® 4Fr child catheter (Terumo Corp. Tokyo, Japan) directly to the coronary artery by ballooning from outside the child catheter. However, this method is complicated due to the requirement for a child catheter. We compared the backup power of the GP-Lock method and other conventional methods in an experimental study and compared the procedural outcomes of 17 cases treated using the initial GP-Lock method with 17 cases using the recent KIWAMI-Lock method before GP-Lock. The GP-Lock method had the highest backup force among the methods examined (GP-Lock: 293.7 ± 10.2 g force (gf), KIWAMI-Lock: 270.4 ± 12.9 gf, side branch balloon anchoring technique: 182.7 ± 8.1 gf, respectively, P < 0.0001). The preparation time was significantly shorter for the GP-Lock group than the KIWAMI-Lock group (5.0 [4.0, 5.0] min vs. 11.0 [8.0, 13.0] min, respectively, P < 0.001). The GP-Lock method makes it possible to easily obtain the strongest backup force, which can overcome situations where devices cannot pass through, especially in complex PCI procedures.
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Affiliation(s)
- Kota Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan.
| | - Satoshi Kameda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Mutsumi Iwamoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Satoshi Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Toshikazu Kashiyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Akinori Sumiyoshi
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Takamasa Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Masatsugu Kawahira
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Heitaro Watanabe
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001, Japan
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Liao J, Wu R, Ma Y, Zhang M, Chen Y, Yao K, Ge J. A novel tapered guide extension catheter facilitated successful completion of complex percutaneous coronary intervention. Eur J Med Res 2023; 28:101. [PMID: 36841827 PMCID: PMC9960653 DOI: 10.1186/s40001-023-01067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Guide extension catheters (GEC) are widely applied to cope with insufficient backup support in complex percutaneous coronary intervention (PCI). In the study, we aim to evaluate the feasibility and safety with a novel 5-4F tapered GEC used in complex lesion. METHODS The single-center retrospective study enrolled a total of 615 patients, in whom the 5F or 5-4F Expressman GEC was used to facilitate PCI procedure. Demographic and procedural data were collected. RESULTS 5F GEC was used in 295 patients and 5-4F tapered GEC in 320 patients. The average age was 63.6 ± 11.0 years and 81.6% of the patients were male. Severe calcification and chronic total occlusion (CTO) were the commonest indication for the GEC use. The 5-4F tapered GEC was frequently used in active greeting technique (AGT) during CTO intervention procedure than 5F GEC (6.1% vs. 13.1%, p < 0.001). The average depth of intubation was 41.5 ± 19.6 mm for the 5-4F tapered GEC and 24.4 ± 15.1 mm for 5F GEC (p < 0.001). The rate of successful device delivery with 5-4F GEC was higher than 5F GEC (95.6% vs. 98.4%, p = 0.037). Pressure damping with 5F GEC occurred frequently than 5-4F GEC (7.4% vs. 2.5%, p < 0.05). Similarly, the incidence of intraoperative hypotension was higher in 5F GEC than 5-4F GEC (4.7% vs.1.9%, p < 0.05). CONCLUSIONS The novel 5-4F tapered GEC was superior to the 5F GEC in facilitating successful completion of PCI in the majority of patients with complex lesions via transradial approach.
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Affiliation(s)
- Jianquan Liao
- grid.8547.e0000 0001 0125 2443Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Runda Wu
- grid.8547.e0000 0001 0125 2443Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuanji Ma
- grid.8547.e0000 0001 0125 2443Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032 China ,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Meng Zhang
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Yaolin Chen
- grid.413087.90000 0004 1755 3939Department of Cardiology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,National Clinical Research Center for Interventional Medicine, Shanghai, China.
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5
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Takigami M, Nakanishi N, Tsubata H, Fukai K, Matsubara Y, Yanishi K, Zen K, Nakamura T, Matoba S. Efficacy and safety of guide extension catheter in balloon pulmonary angioplasty for treatment of complex lesions in chronic thromboembolic pulmonary hypertension. PLoS One 2023; 18:e0280683. [PMID: 36706099 PMCID: PMC9882884 DOI: 10.1371/journal.pone.0280683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Masao Takigami
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- * E-mail:
| | - Hideo Tsubata
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kuniyoshi Fukai
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan
| | - Yuki Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Simple percutaneous coronary intervention strategy with a novel guide extension catheter through a 5-Fr guiding catheter for a tortuous coronary artery. J Cardiol Cases 2022; 26:297-300. [DOI: 10.1016/j.jccase.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
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Mattesini A, Demola P, Parikh SA, Secco GG, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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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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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Differences in primary indication for guide-extension catheter usage among the three target vessels. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:192-197. [PMID: 32636905 PMCID: PMC7333197 DOI: 10.5114/aic.2020.96063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/17/2020] [Indexed: 12/05/2022] Open
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Fukagawa T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Mori S, Sakamoto Y, Tsutsumi M, Honda Y, Makino K, Mizusawa M, Shirai S, Ito Y. Usefulness of a Guide Extension Catheter in Endovascular Therapy of Infrapopliteal Lesions. Ann Vasc Surg 2020; 66:670.e9-670.e14. [DOI: 10.1016/j.avsg.2020.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/05/2020] [Indexed: 11/25/2022]
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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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Kameda S, Okamura A, Sakata Y, Fujii K. Guide catheter extension lock enables the strongest backup force during the antegrade approach in percutaneous coronary intervention. Cardiovasc Interv Ther 2019; 35:177-184. [PMID: 31175575 DOI: 10.1007/s12928-019-00596-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
Sufficient guide catheter backup is crucial for successful percutaneous coronary intervention (PCI). We have developed a new technique for locking a small child catheter to the vessel wall by balloon dilatation outside the child catheter at the proximal site of the main branch. We call this the "guide catheter extension lock" ("Kiwami® lock", Kiwami® child catheter, Terumo Corp. Tokyo, Japan). The guide catheter extension lock backup force was evaluated in an experimental model, and we report a case of chronic total occlusion treated with PCI using this technique. The guide catheter backup force was measured using an artificial cardiac vessel model with a right coronary artery and side branch. We evaluated the backup forces of the guide catheter extension lock and other techniques using an 8Fr Judkins right guide catheter (child catheter: 45.0 ± 4.6 g force [gf]; a 7Fr delivery catheter (Guide-Liner®, Vascular Solutions, Minneapolis MN, USA): 67.4 ± 14.4 gf; an anchoring balloon technique at the side branch: 98.3 ± 11.9 gf; and the guide catheter extension lock: 112.1 ± 13.0 gf). The guide catheter extension lock technique provided the strongest backup force. Our clinical experience shows that this technique is effective during PCI.
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Affiliation(s)
- Satoshi Kameda
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka, 530-0001, Japan. .,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenshi Fujii
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka, 530-0001, Japan
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Tanriverdi Z, Gungoren F, Besli F, Tascanov MB. Comparison of GuideLiner versus Guideplus catheter in complex percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:436. [PMID: 30827927 DOI: 10.1016/j.carrev.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Chen Y, Shah AA, Shlofmitz E, Khalid N, Musallam A, Khan JM, Iantorno M, Gajanana D, Rogers T, Hashim H, Bernardo NL, Waksman R. 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. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:409-412. [PMID: 31079818 DOI: 10.1016/j.carrev.2019.02.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Yuefeng Chen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Arhum A Shah
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Micaela Iantorno
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Deepakraj Gajanana
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Mitomo S, Demir OM, Latib A, Colombo A. Buddy-wire technique during rotational Atherectomy: Simple and effective solution to achieve strong back-up support. Catheter Cardiovasc Interv 2018; 93:436-439. [PMID: 30244541 DOI: 10.1002/ccd.27873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/29/2018] [Accepted: 08/20/2018] [Indexed: 01/11/2023]
Abstract
A 52-year-old male underwent percutaneous coronary intervention (PCI) using rotational atherectomy (RA: 1.5-mm burr) for a severely calcified lesion in the proximal to mid obtuse marginal (OM) branch. Even with 7 Fr extra back-up guiding catheter via femoral access, the burr could not cross the lesion due to insufficient back-up support. In order to achieve stronger back-up support, we kept the burr at the position in the OM branch and placed a supportive wire in left anterior descending artery through the side of drive-shaft sheath of the Rotablator, which sufficiently stabilized the guiding catheter during the ablation and the burr crossed the lesion. This case demonstrates that a simple technique of placing additional supportive wire in the other vessel during RA could be an effective and safe solution to facilitate improved back-up support without necessity to change the PCI system used already.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy
| | - Ozan M Demir
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy
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17
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D'Amario D, Galli M, Vergallo R, Crea F, Porto I. How deep is your lesion? Extreme guideliner V3 intubation through RIMA graft to treat a distal left anterior descending artery stenosis. J Cardiovasc Med (Hagerstown) 2018; 19:606-608. [PMID: 30004949 DOI: 10.2459/jcm.0000000000000698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Domenico D'Amario
- Interventional Cardiology Unit, Department of Cardiovascular Sciences, 'A. Gemelli' Foundation Hospital, Catholic University of the Sacred Heart, Rome, Italy
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18
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Ali M, Yagoub H, Ibrahim A, Ahmed M, Ibrahim M, Saunders J, Brennan A, Cahill D, Hennessy T, Hynes BG, Arnous S, Kiernan TJ. Anchor-balloon technique to facilitate stent delivery via the GuideLiner catheter in percutaneous coronary intervention. Future Cardiol 2018; 14:291-299. [PMID: 29927308 DOI: 10.2217/fca-2017-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Mohamed Ali
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Hatim Yagoub
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Abdalla Ibrahim
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Mohamed Ahmed
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Munir Ibrahim
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Jean Saunders
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
| | - Alice Brennan
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Donal Cahill
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Terence Hennessy
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Brian G Hynes
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Samer Arnous
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
| | - Thomas J Kiernan
- Cardiology Department, University Hospital Limerick, Limerick, Ireland
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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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20
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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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21
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Horie K, Tada N, Isawa T, Matsumoto T, Taguri M, Kato S, Honda T, Ootomo T, Inoue N. A randomised comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using 6.5 Fr SheathLess Eaucath Guiding Catheter vs. 6.0 Fr Glidesheath Slender. EUROINTERVENTION 2018; 13:2018-2025. [DOI: 10.4244/eij-d-17-00239] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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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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23
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Huang Z, Zhang B, Chai W, Ma D, Liao H, Zhong Z, Wang F, Lin J. Usefulness and Safety of a Novel Modification of the Retrograde Approach for the Long Tortuous Chronic Total Occlusion of Coronary Arteries. Int Heart J 2017; 58:351-356. [PMID: 28539570 DOI: 10.1536/ihj.16-337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the feasibility and efficacy of the Guidezilla guide extension catheter in a reverse controlled antegrade and retrograde subintimal tracking (CART) technique for chronic total occlusion (CTO) recanalization.We retrospectively collected 80 CTO cases using reverse CART technology from January 2015 to October 2015 and 20 CTO cases using Guidezilla reverse-CART technology from October 2015 to March 2016. Guidezilla was applied in cases when it was difficult to advance a retro-guidewire through an occlusion segment into the antegrade guide catheter.The Guidezilla group had more cases with an occlusion longer > 20 mm (100.0% versus 72.5%, P = 0.005) and "bending > 45°" (90.0% versus 63.7%, P = 0.029) than the non-Guidezilla group, while the non-Guidezilla group had more retry lesions (25.0% versus 63.8%, P = 0.002). The septal collateral channel was the preferred choice for retro-recanalization in both groups (90.0% in Guidezilla group and 68.8% in non-Guidezilla group). All cases in the Guidezilla group achieved technical success with a TIMI 3 flow in the distal true lumen (100.0% versus 75.0% in non-Guidezilla group, P = 0.010). Cardiac tamponade and perforation in the epicardial artery was observed in 1 case each in the Guidezilla group. In the non-Guidezilla group, 19 complications occurred during the PCI procedure. No target vessel revascularization or in-hospital death occurred in either group.CTO lesions using the Guidezilla guide extension catheter to facilitate entry to an antegrade catheter in reverse CART technology is convenient and safe with a high success rate.
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Affiliation(s)
- Zehan Huang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Bin Zhang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Weilu Chai
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Dunliang Ma
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Hongtao Liao
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Zhian Zhong
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Feng Wang
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
| | - Jingye Lin
- Second Division, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital
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24
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Brown BJ, Abbott JD. A helping hand: GuideLiner use to facilitate stent delivery. Catheter Cardiovasc Interv 2016; 88:1065-1066. [PMID: 27976540 DOI: 10.1002/ccd.26866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022]
Abstract
The GuideLiner catheter system is a tool that can be used to increase procedural success in complex percutaneous coronary intervention. The safety profile of the device has improved with successive generations and with increased operator experience. Methods to utilize the GuideLiner safely and effectively are described in this article.
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Affiliation(s)
- Brian J Brown
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | - J Dawn Abbott
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
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25
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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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26
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Parikh SA, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sahil A. Parikh
- Harrington Heart & Vascular Institute; Case Western Reserve University School of Medicine; Cleveland OH USA
| | - Michele Pighi
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Imperial College London; UK
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27
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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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28
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Off-label use of 7Fr GuideLiner in the bifurcation coronary intervention protecting 2 side branches. Cardiovasc Interv Ther 2016; 32:392-395. [PMID: 27757830 DOI: 10.1007/s12928-016-0435-8] [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: 07/19/2016] [Accepted: 09/27/2016] [Indexed: 12/14/2022]
Abstract
We report a case of percutaneous coronary intervention in a bifurcation lesion involving left circumflex (LCx) artery and 2 major posterolateral (PL) arteries. The target LCx had diffuse long and severely calcified lesion with the acute takeoff angle from the left main. Despite adequate lesion preparation with rotational atherectomy and balloon angioplasty, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. Conventional use of guiding extension catheter (GEC) would have required removal of a wire from at least one PL because of the device interference in the GEC. However, successful stenting was achieved without removal of wires from both PL with 7Fr GuideLiner. We have also demonstrated this mechanism on ex vivo bench testing.
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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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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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Warisawa T, Ishiguro H, Nakajima A, Nakamura S. Novel "baby-in-mother" technique with the GuideLiner in the bifurcation coronary intervention with the protect-wire kept in the side branch. Cardiovasc Interv Ther 2016; 32:254-258. [PMID: 27277536 DOI: 10.1007/s12928-016-0402-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
We report a case of percutaneous coronary intervention in a bifurcation lesion involving the left anterior descending artery and the first-diagonal branch. The lesion was calcified with vessel tortuosity. Despite adequate lesion preparation using scoring balloon, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. The use of 6-in-7 guiding extension catheter would have required removal of wire from the diagonal branch. To avoid this situation, we down-sized the extension catheter to 5Fr, which was successful in delivering the stent without removal of the wire from diagonal branch. We have also demonstrated this novel technique on ex vivo bench testing.
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Affiliation(s)
- Takayuki Warisawa
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Hisaaki Ishiguro
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Akihiro Nakajima
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
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Are catheter extension devices one step forward for complex coronary interventions? Anatol J Cardiol 2016; 16:342-3. [PMID: 27240608 DOI: 10.14744/anatoljcardiol.2016.00014] [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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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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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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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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Successful delivery of polytetrafluoroethylene-covered stent using rapid exchange guide extension catheter. Cardiovasc Interv Ther 2016; 32:142-145. [DOI: 10.1007/s12928-016-0378-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
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Alkhalil M, Smyth A, Walsh SJ, McQuillan C, Spence MS, Owens CG, Hanratty CG. Did the use of the Guideliner V2(TM) guide catheter extension increase complications? A review of the incidence of complications related to the use of the V2 catheter, the influence of right brachiocephalic arterial anatomy and the redesign of the V3(TM) Guideliner and clinical outcomes. Open Heart 2016; 3:e000331. [PMID: 26848394 PMCID: PMC4731838 DOI: 10.1136/openhrt-2015-000331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/17/2015] [Accepted: 12/05/2015] [Indexed: 11/04/2022] Open
Abstract
Objective We sought to investigate the incidence of complications associated with V2 Guideliner, understand the mechanisms and evaluate the impact of alterations made to the V3 Guideliner. Methods Retrospective analysis of consecutive cases employing V2 Guideliner from two university teaching hospitals. Complications were identified, analysed and classified into major versus minor ones. To understand the potential anatomical mechanism of these complications, analysis of normal great vessel anatomy was undertaken in separate cohort of patients undergoing cardiac catheterisation via right radial approach. Further analysis of consecutive cases employing V3 Gudieliner took place and the incidence of complications were compared between V2 and V3 groups. Results Total of 188 cases of V2 Guideliner use were identified. One major complication was reported (coronary dissection). Proximal collar interaction and stent damage occurred in 19 cases (10%). Anatomical data suggest that extending the V2 Guideliner tubing sited the proximal collar of the device in the brachiocephalic/subclavian artery, a potential site of tortuosity and potential cause of the Guideliner proximal collar-stent interaction. Further analysis of 124 cases of V3 Guideliner use demonstrated no cases with proximal collar-stent interactions, one case of longitudinal stent deformation and two incidents of stent interaction with the distal edge of the V3 Guideliner. Conclusions We have demonstrated a higher incidence of V2 Guideliner complications compared to previous series. The change in design of the V2 Guideliner was a likely contributor but the modifications with V3 Guideliner appear to have ameliorated this issue.
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Affiliation(s)
| | - Alison Smyth
- Cardiology Department , Belfast City Hospital , Belfast , UK
| | - Simon J Walsh
- Cardiology Department , Belfast City Hospital , Belfast , UK
| | - Conor McQuillan
- Cardiology Department , Royal Victoria Hospital , Belfast , UK
| | - Mark S Spence
- Cardiology Department , Royal Victoria Hospital , Belfast , UK
| | - Colum G Owens
- Cardiology Department , Royal Victoria Hospital , Belfast , UK
| | - Colm G Hanratty
- Cardiology Department , Belfast City Hospital , Belfast , UK
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Guidezilla guide extension catheter facilitated the delivery of long and bulky In.Pact Falcon drug-coated balloon for the treatment of chronic total occlusion lesion. Int J Cardiol 2015; 201:220-1. [PMID: 26298384 DOI: 10.1016/j.ijcard.2015.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/01/2015] [Indexed: 12/13/2022]
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Fairley SL, Spratt JC, Rana O, Talwar S, Hanratty C, Walsh S. Adjunctive strategies in the management of resistant, 'undilatable' coronary lesions after successfully crossing a CTO with a guidewire. Curr Cardiol Rev 2015; 10:145-57. [PMID: 24694106 PMCID: PMC4021284 DOI: 10.2174/1573403x10666140331124954] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/15/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various 'offlabel' settings.
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Affiliation(s)
| | | | | | | | | | - Simon Walsh
- Cardiology Department, Belfast Health and Social Care Trust, UK, BT9 7AB, UK.
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García-Blas S, Núñez J, Mainar L, Miñana G, Bonanad C, Racugno P, Rodríguez JC, Moyano P, Sanchis J. Usefulness and safety of a guide catheter extension system for the percutaneous treatment of complex coronary lesions by a transradial approach. Med Princ Pract 2015; 24:171-7. [PMID: 25531292 PMCID: PMC5588208 DOI: 10.1159/000369620] [Citation(s) in RCA: 9] [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] [Received: 05/21/2014] [Accepted: 11/06/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. MATERIALS AND METHODS The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. RESULTS Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. CONCLUSION Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded.
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Affiliation(s)
- Sergio García-Blas
- *Sergio García-Blas, Department of Cardiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, ES-46010 Valencia (Spain), E-Mail
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The novel 4.5F CoKatte catheter for stent delivery facilitation in complex coronary artery lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:346-9. [PMID: 25204492 DOI: 10.1016/j.carrev.2014.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 07/26/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The mother and child technique with a deep-seated 4F Kiwami catheter has been reported to be effective for delivering stents to complex lesions. OBJECTIVES To assess the feasibility and efficacy of a novel 4.5F child catheter for deep insertion and stent deployment into the distal coronary artery for the treatment of complex lesions. METHOD We retrospectively evaluated 51 consecutive patients, who underwent percutaneous coronary intervention between January 2011 and December 2013, using a 4.5F CoKatte catheter after stent delivery failure using the conventional procedures. We evaluated the procedure success, need for an additional anchor balloon technique, and complications related to the deep insertion. RESULTS Stent delivery to the intended lesion was successful in all cases. For advancement and subsequent deep intubation of the catheter, 42 lesions required the additional anchor balloon technique. No complications, including proximal dissection, air embolism, and severe ischemia, were observed in relation to the deep insertion of the catheter. CONCLUSION Percutaneous coronary intervention with the novel 4.5F catheter is a safe and effective method, which can facilitate stent delivery to a complex coronary lesion.
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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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Novel Use of the GuideLiner Catheter to Deliver Rotational Atherectomy Burrs in Tortuous Vessels. Case Rep Cardiol 2014; 2014:594396. [PMID: 25140260 PMCID: PMC4129961 DOI: 10.1155/2014/594396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022] Open
Abstract
Rotational atherectomy (RA) for heavily calcified lesions is essential for improved stent delivery and stent expansion. In tortuous vessels it is often difficult to advance the burr without rotation and possible injury to the endothelium of healthy vessel. The GuideLiner catheter, a child in mother catheter, has recently been used to allow for increased support for delivery of stents through tortuous vessels. We report a novel use of the GuideLiner for the delivery of an RA burr in tortuous vessels requiring increased guide support.
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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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Sambu N, Fernandez J, Shah NC, O’Kane P. The GuideLiner ®: an interventionist’s experience of their first 50 cases: “the mostly good, rarely bad, beware of the ugly!”. Interv Cardiol 2013. [DOI: 10.2217/ica.13.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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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