The GL was then advanced through the proximally deployed stent (over the balloon shaft) inorder to effectively deliver the 3 × 23 mm distal Cypher stent. Therefore,the stent was deployed in this proximal position.
#Guideliner vascular solutions full
After predilatation with full balloon expansion, an attempt was made to deliver a 3.5 × 33 mm Cypher (CordisCorporation, NJ, USA) stent to the distal lesion, but it would not cross the proximal lesion and could not be retracted into the GC. (B and C) The RCA was engaged transfemorally with an All Right 4 GC (Boston Scientific, MA, USA) and the lesion is crossed with a Luge™wire (Boston Scientific). (A) Severe diffuse disease in the RCA of a 79-year-old male with unstable angina. GC: Guide catheter GL: GuideLiner ® PDA: Posterior descending artery RCA: Right coronary artery.įigure 8: Advancement of the GuideLiner ® (Vascular Solutions, MN, USA) through a proximally deployed stent allowing themore distal lesion to be subsequently treated. (iii) The GL was, therefore, advanced to mid vessel andthree Promus Element stents (3.5 × 24 4 × 28 and 4 × 28 mm) were succsessfully delivered and deployed. After two burr rotational atherectomy, a 3.5 × 20 mmnoncompliant balloon expanded fully. This was then exchanged for a rota wireusing a Fine Cross™ microcatheter (Terumo Corporation, Tokyo, Japan). (ii) The RCA was engaged transfemorallywith an Amplatz 0.75 GC and the lesion initially crossed with a Balance Middleweight Wire. (i) Heavily calcified, severe RCA disease. (B) Stent delivery in a calcified and tortuous vessel after rotationalatherectomy in a 61-year-old male with stable angina. Following laser atherectomy, sequential balloon dilatation of the lesion was performedand four Promus Element™ stents (2.25 × 12 2.75 × 20 3.5 × 20 and 3.5 × 24 mm ) were successfully delivered anddeployed from distal to mid vessel. (iii) With the GL deeply intubated, a 0.9-mm laser catheter was delivereddistally in order to effectively debulk the lesion. The lowest profile balloon (1.2 × 12 mm) would not cross the posteriordescending artery lesion despite an advanced GL position. Distal balloon deliveryfailure was encountered due to suboptimal GC support and the GL (Vascular Solutions, MN, USA) was therefore required to facilitatedeep vessel intubation and provide effective backup support. (ii) The RCA was engaged transradially with an Amplatz 1.0 GC (BostonScientific, MA, USA) and the lesion crossed with a Balance Middleweight™ Wire (Abbott Laboratories, IL, USA).
(i) Severe distal RCA lesion and a severelesion in the PDA branch extending back to the ostium. (A) Stent delivery in acalcified vessel after laser atherectomy in a 66-year-old male admitted with unstable angina. (D) The final angiographic result with thrombolysis in myocardial infarction grade III flow.GC: Guide catheter GL: GuideLiner ®.įigure 4: Stent delivery within a tortuous and/or calcified vessel after rotational or laser atherectomy. (C) The GL was thendeeply intubated to permit distal lesion predilatation and stent delivery (Tsunami ® 3 × 15 mm and 3.5 × 10 mm ). Proximal balloon dilatation wasrequired in order to deliver the GL (Vascular Solutions, MN, USA) distally as the proximal lesion was obstructive. Balloon delivery failure wasencountered due to marked vessel calcification and tortuosity particularly at the mid vessel U-bend. (B) The right coronary artery was engaged transfemorally with an Amplatz 0.75GC (Boston Scientific, MA, USA) and the lesion crossed with a PT Graphix™ Wire (Boston Scientific). (A) Heavily calcified andtortuous right coronary artery that was occluded distally. (F) The final angiographic result.GC: Guide catheter GL: GuideLiner ®.įigure 3: Deep vessel intubation to facilitate distal balloon and stent delivery in an 85-year-old male on peritoneal dialysisundergoing primary percutaneous coronary intervention for an ST-elevation myocardial infarction. (E) It was successfully delivered anddeployed in the circumflex artery. (D) The stent (3.5 × 16 mmPromus Element™ ) was advanced through the metal collar of the GL. (C) Deep vessel intubation and effective backup support was achieved by deliveringthe GL catheter into the vessel over a balloon shaft, thus negating the effect of the proximal tortuosity. Following predilatation, stent deliveryfailure was encountered due to severe tortuousity. (B) Thecircumflex artery was engaged with an Extra backup 3.5 GC (Medtronic, MN, USA) and the calcified lesion was crossed using a BalanceMiddleweight™ Wire (Abbott Laboratories, IL, USA) and the support of a 2.0 × 12 mm balloon. (A) Subtotally occluded calcific proximal circumflex artery in a markedly tortuous vessel. Figure 2: Transfemoral GuideLiner ® catheter (Vascular Solutions, MN, USA) delivery technique in a 70-year-old maleadmitted with unstable angina.
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