Techniques to aid stent delivery include vessel straightening using buddy wires and support wires, vessel preparation using rotational atherectomy and high pressure dilatation, and methods to increase backup support such as deep intubation, anchor balloon techniques and the use of guide catheter extensions (GC extensions). Improvements in stent design have been matched by increasing case complexity such that failure to deliver a stent remains one of the commonest causes of procedural failure. The combination of calcification and tortuosity remains a significant challenge to the interventional cardiologist due to poor lesion compliance and difficulties with stent delivery. Moreover, the aim of this article is to help interventional cardiologists using the device in difficult lesions to avoid potential complications. We describe here our experience with the Guideliner catheter for stent delivery and backup support we discuss its utility and drawbacks in acute and stable clinical settings. In our experience, the Guideliner catheter is safe to use and helps device delivery in difficult settings. In 2 cases, we had stent damage due to the passage of the stent through the Guideliner metal collar. Three proximal dissections were detected and sealed with stent implantation. The other 9 cases were performed successfully. One case, the first one, failed, as stent could not be delivered to the target lesion. In 2 cases PTCA with drug-eluting balloon was performed in the other cases second-generation drug-eluting stent was implanted. In 3 cases the operator chose the femoral access, in 2 cases crossover from radial to femoral access was needed, and the other cases were performed radially. Recently, a new support rapid exchange catheter, the Guideliner, has been designed specifically for device delivery.įrom June 2010 to December 2010, we performed 10 cases using the Guideliner catheter to improve backup support and facilitate stent delivery: 2 emergent PCI for ST elevation myocardial infarction, and 8 stable elective PCI. doi: 10.1007/s1292-1.Stent delivery in complex coronary anatomy with severe calcification and tortuosity is still a common cause of percutaneous coronary interventions (PCI) failure. Successful endovascular treatment with GuideLiner catheter of chronic aortic occlusion with severe calcification. Kubota H, Kato T, Nomura T, Keira N, Tatsumi T. Successful percutaneous coronary intervention with GuideLiner ® catheter for subtotal occlusive lesion in the right coronary artery with anomalous origin from the left sinus of Valsalva: a case report. Shirota A, Nomura T, Kubota H, Taminishi S, Urata R, Sugimoto T, et al. GuideLiner catheter facilitated PCI-a novel device with multiple applications. Distal stent delivery with Guideliner catheter: first in man experience. Successful delivery of polytetrafluoroethylene-covered stent using rapid exchange guide extension catheter. Short-term and long-term outcomes after polytetrafluoroethylene-covered stent implantation for the treatment of coronary perforation. Kawamoto H, Tanaka K, Ruparelia N, Takagi K, Yabushita H, Watanabe Y, et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Lansky AJ, Yang YM, Khan Y, Costa RA, Pietras C, Tsuchiy Y, et al. Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures. 1994 32:206–12.īriguori C, Nishida T, Anzuini A, Di Mario C, Grube E, Colombo A. Perforation after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. 1993 21:1158–65.Ījluni SC, Glazier S, Blankenship L, O’Neill WW, Safian RD.
The percutaneous Excimer Laser Coronary Angioplasty Registry. Coronary artery perforation during excimer laser coronary angioplasty. 1994 90:2725–30.īittl JA, Ryan TJ Jr, Keaney JF Jr, Tcheng JE, Ellis SG, Isner JM, et al.
Incidence, classification, management and outcome. Increased coronary perforation in the new device era. 2010 75:708–12.Įllis SG, Ajluni S, Arnold AZ, Popma JJ, Bittl JA, Eigler NL, et al. Dual catheter technique for the treatment of severe coronary artery perforations. Ben-Gal Y, Weisz G, Collins MB, Genereux P, Dangas GD, Teirstein PS, et al.