![]() ![]() ![]() 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. The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events. We aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters. 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. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. The overall success rate was 88.9 ± 0.32% there were no relevant complications. All procedures were performed femorally the retrograde approach was used in 27.8 ± 0.46% of cases. The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes.Īlmost all lesions were classified as severely calcified (94.4 ± 0.24%). We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use. Interventional cardiologists must be aware of this potential use of the “mother-and-child” technique.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 GuideLiner may be a useful adjunct for rotablation when the rotating burr cannot cross a tight, calcified stenosis and more support is needed. It is prudent to avoid large burrs because of the risk of entrapment in the GuideLiner. Caution is needed to position the burr distal to the GuideLiner before starting any forward rotation to avoid potential damage and shear of the “child” catheter. However, its use to deliver the rotablation burr (3) is off-label and has been reported only once (4). The GuideLiner has been previously used to retrieve a trapped rotaburr (2). The GuideLiner is a guide catheter extension used for the “mother-and-child” technique, which improves support through deep intubation of the target vessel and thus facilitates delivery of stents in tortuous or calcified vessels (1). The PCI was completed with standard techniques, with excellent results ( Figure 1C). This maneuver obviously “stiffened” the guide catheter-rotawire-rotablation catheter assembly and enabled the rotating burr to cross the heavily calcified stenosis. We eventually managed to rotablate the calcified stenosis after we advanced a 6-F GuideLiner (“mother-and-child” technique) (Vascular Solutions Inc., Minneapolis, Minnesota) proximal to the stenosis ( Figure 1B, Online Video 3). However, we were initially unable to cross the stenosis with the rotating 1.25-mm burr. We used a left femoral access, a long sheath, and an Amplatz Left 1 guide catheter (Boston Scientific, Natick, Massachusetts) to optimize support. Final result after right coronary artery stent deployment (left anterior oblique view) ( Online Video 3). ![]() (C) Right coronary angiogram post rotational atherectomy. Rotaburr crossing the lesion with the support of the GuideLiner (left anterior oblique view) ( Online Video 2). (B) Rotational atherectomy supported by the GuideLiner. Tight calcified stenosis in the midportion of the right coronary artery (left anterior oblique view) ( Online Video 1). (A) Right coronary angiogram pre-rotational atherectomy. GuideLiner-Facilitated Rotational Atherectomy in Calcified Right Coronary Artery Download Figure Download PowerPoint Figure 1.
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