Guide catheter extensions: where are they taking us?

Abstract

The combination of calcification and tortuosity remains a significant challenge to the interventional cardiologist due to poor lesion compliance and difficulties with stent delivery. 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. 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). GC extensions include over-the-wire devices such as the 5 Fr -in-6 Fr Heartrail II and 4 Fr -in-6 Fr Kiwami catheters (Terumo, Tokyo, Japan) and the rapid exchange GuideLiner catheter (Vascular Solutions, Maple Grove, MN, USA). Kiwami is not available in Europe. In this issue of EuroIntervention, Frits de Man et al report the largest cohort to date of patients undergoing PCI with the aid of the 6 Fr compatible GuideLiner catheter (5 Fr-in-6 Fr system) 1 . The cases are performed by experienced operators from a single centre and indications include backup support and stent delivery (41 cases), improvement in catheter alignment (20 cases) and selective contrast injection (20 cases). Of five device failures, all involved failure to deeply intubate the device, either due to proximal vessel disease (four cases) or iliac tortuosity. There were no major device related complications and specifically no cases of vessel dissection or embolisation despite intubation depth of up to 10.6 cm (mean 3.3 cm). These findings are in keeping with reported series using GC extensions in which stent delivery is the commonest indication, device related complications are rare and procedural success exceeds 90%, with failures largely due to the inability to deeply intubate 2-6