![]() ![]() However, no prior study has examined the utility and predictors of GuideLiner use as an adjunctive tool for TRI. Early reports demonstrated successful application of this catheter extension for complex TF coronary interventions including vein and LITA grafts,. The GuideLiner catheter (Vascular Solutions, Minneapolis, MN) is a novel “mother and child” rapid exchange atraumatic guide catheter extension that allows deep vessel intubation with minimal trauma to the native coronary artery. With many new operators adopting radial catheterization and TRI, improved techniques to facilitate successful completion of the procedure could have significant advantages. More aggressive radial-specific guides can also be used, but these may also result in proximal vessel injury. However, most guide catheters are designed for support at the coronary ostia and such maneuvers can traumatize the target coronary artery. One technique to overcome lack of guide catheter support includes deep intubation of the guide catheter. Since most guide catheters were also designed for a TF approach, they may provide less backup support and coaxial alignment for TRI. As a result, less guide backup force is generated. Specifically, guide catheters advanced from the right radial artery often approach the coronary ostia from a vertical downward approach, which excludes the aortic arch. ĭuring trans-radial cardiac catheterization, the anatomic and geometric characteristics of the ascending aorta relative to the catheter differ significantly from TF angiography. Additionally, anatomic variations and lack of guide catheter support increase the technical complexity of TRI. Barriers to TRI include a steep initial learning curve and time required to gain proficiency at TRI. Although TRI is increasingly common, it currently represents < 10% of all PCIs in the USA. 5 ).Transradial coronary intervention (TRI) is associated with significantly reduced rates of bleeding and access site related complications compared to the transfemoral (TF) approach. 4 ), which also offered robust GC support, enabling direct stenting of the lesion with a 3×12-mm Promus stent ( Fig. Excellent visualization of the lesion was obtained following deep intubation of the left circumflex with a 6F GuideLiner ( Fig. A decision was taken to approach this lesion via the native circumflex, rather than via the graft, because of a 90° angle between the graft and the OM. 2 ), it was poorly visualized via native vessel angiography due to competitive flow from the graft ( Fig. Although the lesion was well visualized via graft angiography ( Fig. Coronary and graft angiography demonstrated a lesion immediately distal to the anastomosis of a SVG with a large obtuse marginal branch (OM). We describe two cases of percutaneous coronary intervention (PCI) involving saphenous vein grafts (SVG) where use of a 6F GuideLiner facilitated the procedure by providing excellent GC support and superior target lesion visualization.Ī 52-year-old male presented with an acute coronary syndrome (ACS). A GuideLiner reduces the internal diameter of the ‘mother’ GC by approximately 1F size it is available in 6F, 7F, and 8F sizes. It has a 20-cm, highly flexible, super soft rapid exchange section which facilitates its insertion and allows the use of standard length guidewires, balloons, or stents through an existing haemostatic valve. 1 ) is a modified ‘child’ guide catheter (GC) which can be delivered through a standard GC, providing an extension for deep seating, added backup support, and coaxial alignment. Recently, several such catheters have become commercially available, including Terumo’s Heartrail II catheter and Vascular Solutions’ GuideLiner catheter. This double-coaxial catheter arrangement is often referred to as ‘mother and child’, with the outer GC being the ‘mother’ and the inner GC being the ‘child’. These limitations may be overcome by deeply intubating the proximal or mid segment of the target vessel with a smaller GC through the outer GC. In situations where percutaneous coronary intervention (PCI) is deemed necessary, such poor visualization may be compounded by poor guide catheter (GC) support, rendering intervention difficult or even impossible. ![]() Visualization of distal vessel run-off following contrast injection in a coronary artery or bypass graft may be poor due to suboptimal ‘seating’ of the catheter or to competitive antegrade or retrograde flow from native vessels. ![]()
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