The use of a guide catheter extension system as an aid during transradial percutaneous coronary intervention of coronary artery bypass grafts

Abstract

Prior coronary artery bypass graft (CABG) surgery is one of the main predictors of failure of transradial PCI. Frequently this is due to difficulty in graft cannulation and/or poor backup support. In addition to Proxis's™ embolic protection role, the Proxis™, Heartrail™, and GuideLiner™ guide catheter extension devices have all been shown to facilitate coronary intervention by increasing backup support and aiding stent delivery. We describe our institution's experiences using these devices to aid transradial graft intervention. Between October 2007 and March 2010, the utility and safety of these devices were assessed in consecutive transradial graft intervention procedures. Proxis™ cases used for proximal protection alone were excluded. Deep intubation was defined as an intubation depth of ≥2 cm. Guide catheter extensions were used in 33 of 41 transradial graft interventions identified. Proxis™ was used for proximal protection alone in 3 cases, leaving 30 cases as the study group (Heartrail™ n = 18, GuideLiner™ n = 3, Proxis™ n = 9). In all study cases procedural success with final TIMI-3 flow was achieved. Guide catheter extensions were used to aid during graft cannulation (n = 11), to improve backup support via deep intubation (n = 26) and as an adjunctive aspiration device (n = 11). Filter-based distal embolic protection devices were used in 11/21 Heartrail™ and GuideLiner™ cases. Deep intubation depths ranged from 30 to 138 mm (mean 61 mm) with no complications related to deep intubation seen. The use of guide catheter extension systems facilitated transradial graft intervention via several mechanisms including aid to graft cannulation, increasing backup support, and as an adjunctive aspiration device.