Case Report
Am Heart Hosp J. 2011;9(1):44–7
Angiographic Success and Successful Stent Delivery for Complex Lesions Using the GuideLiner™ Five-in-six System— A Case Report
Anouska Moynagh, MD,1 Philippe Garot, MD, FESC,2 and Yves Louvard, MD, FSCAI3 Thierry Lefèvre, MD, FSCAI, FESC3
In this report, we describe two cases of transradial intervention of chronic total occlusions assisted by the GuideLiner catheter when the guide catheter support was suboptimal. This novel coaxial system can provide additional support for more complex lesions and, in our cases, allowed the procedure to be completed via the transradial approach rather than having to change to transfemoral access.
he transradial approach (TRA) is emerging as a successful method for coronary intervention. It provides the additional benefits of earlier ambulation, a reduction in staff workload, and, most importantly, a reduction in the rate of access site complications, when compared with the transfemoral approach (TFA).1–5
T However, it also has limitations. Owing
to the smaller size of the radial artery, the choice of guiding catheter (GC) size is limited, with the maximal acceptable diameter being 6 Fr in the majority of cases and as a result back up support is compromised.6
A number of
techniques have been used in order to try to improve the support.7–11
Recently, the ‘mother-and-child’ technique, using a five-in-six system, has emerged as a powerful tool to increase back-up support.11
The GuideLiner™ (Vascular Solutions, Inc., Minneapolis, MN) (see Figure 1 and 2) catheter is a new coaxial mother- and-child guide extension. After crossing the lesion with a conventional guide wire (GW), the GuideLiner is used as an inner catheter and inserted inside the 6 Fr GC, creating a mother-and-child system, and can be used to intubate the coronary artery. This improves the back-up support and allows selective deep intubation in difficult coronary cases enabling easier balloon and/or stent crossing.11–13
In this report we show our first experiences of the GuideLiner catheter in two consecutive cases of chronic total occlusions of the right coronary artery in which the device was able to solve the technical difficulties associated with these complex procedures.
Case Report Case One
A 53-year-old man presented with class two stable angina. Cardiovascular risk factors included hypertension, dyslipidemia, and a history of smoking. Coronary angiography revealed a chronic total occlusion (CTO) of the mid right coronary artery (RCA) with collateralisation from the left system. Subsequent cardiac magnetic resonance imaging (MRI) revealed inferolateral ischemia with viability in this territory. The decision was made to proceed with percutaneous coronary intervention (PCI) of the RCA.
PCI was performed through the right TRA using a 6 Fr Judkins Right (JR4.0, Launcher) GC, with the left TRA being used for contralateral injections. The origin of the RCA was anomalous and difficult to engage with subsequent poor GC support and difficult GW manipulation (see Figure 3). The GuideLiner catheter was inserted into the 6 Fr GC, to obtain better back-up support. After deep intubation of the
• Correspondence: Yves Louvard, MD, FSCAI, Institut Hospitalier Jacques Cartier, 6 rue du Noyer Lambert, 91300 Massy, France. E:
y.louvard@icps.com.fr 44 Angiographic Success and Successful Stent Delivery for Complex Lesions Using the GuideLiner™ Five-in-six System Summer 2011
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68