GuideLiner Catheter Research Articles

Percutaneous Intervention With GuideLiner Catheter in 4 Patients With Anomalous Coronary Artery Originating From Opposite Sinus of Valsalva.

Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.

Successful retrieval of a stuck rotablator burr and PTCA balloon by using a guideliner catheter at complex LAD lesion: A case report

ackground: An entrapped rotablator burr is a rare but severe complication of Rotational Atherectomy (RA), and surgical removal is invasive and takes several hours. Therefore, a less invasive measure is necessary for this complication. Case summary: A 54-year-old man with Diabetes Mellitus (DM) and hypertension revealed chronic total occlusion in the proximal LAD In-Stent Restenosis (ISR). The left coronary ostium was engaged with 7Fr EBU. A Runthrough was inserted into D1, and the XTR guidewire was inserted into distal LAD using Guideliner catheter. Because of the severe angulated calcified lesion at the proximal LAD, the 1.0 balloon could not pass the lesion, so we performed rotablation. The burr suddenly became trapped within the calcified lesion at the distal angulated edge. We performed a gentle manual retraction of the rota and attempted to insert another guidewire to alongside the burr for balloon dilation to free the burr, but wiring failed. Then, we cut off the drive sheath of the rota, inserted a 5.5 Fr Guideliner catheter through the remaining system and fixed the catheter tip near the entrapped rotablator burr by pushing and pulling the rotablator at the same time. Finally the rota system was removed successfully, but the burr was nearly detached from the rota wire during retraction. Discussion: We might get an information of the degree of fibrous and angulated calcification by MDCT before PCI and this will be helpful to predict the possibility of bur stuck. A large size sheath and femoral approach may be preferable.

P3630Coronary angiography and percutaneous coronary intervention post implantation of a transcatheter aortic valve

Abstract When treating younger patients with longer life expectancy, the likelihood of having to perform a subsequent coronary angiogram and PCI during follow-up post transcatheter aortic valve implantation (TAVI) is increased. The aim of our study was to assess the feasibility and characteristics of the post TAVI coronary angiogram. We interrogated our prospective single center TAVI database to analyze data from patients who underwent a coronary angiogram or PCI post TAVI. Between August 2008 and January 2019, 405 consecutive TAVI were performed in our institution with a 30-day, 6-month and yearly follow-up. Among 405 procedures, 18 coronary angiograms with 9 PCI (RCA 2; LM 3; LAD 3, LCX 1) were performed in 17 patients post TAVI. The mean age of patients was 78.1±7.5 years (3 women), with a mean STS score of 5.6±3.4%. Five patients had a history of prior CABG. The transcatheter heart valves implanted were 6 CoreValve, 8 Evolut R, 1 Evolut Pro and 2 Edwards Sapien. The valve sizes were 31mm (n=3), 29mm (n=6), 26mm (n=3) and 23mm (n=5). The indication for the coronary angiogram was acute coronary syndrome for 8 procedures (1 STEMI, 7 NSTEMI) and stable angina for the remaining 10 procedures. The mean time between TAVI and coronary angiogram was 519±332 days (189–1093 days). Femoral and radial approach was used in, respectively, 11 and 7 (right: 5, left: 2) procedures with one cross-over needed from right transradial to transfemoral. Out of 33 attempted ostia cannulations, there were 2 failures (both involving the RCA), and 31 successes classified as selective (RCA: 7, LM: 9), borderline selective (RCA: 3, LM: 2) and non-selective but sufficient for diagnosis (RCA: 3, LM: 7), using standard catheters (average number of catheter used to cannulate RCA: 1.2±0.8 and LM: 1.7±1.1 [min. 1 and max. 4]). All planned PCI were successful with the treatment of 11 stenosis including 2 multivessel lesions. In 44% of the treated arteries, the use of a GuideLiner catheter (Vascular Solutions Inc) was required to cannulate the ostium. In conclusion, coronary angiogram post TAVI was needed in 4.2% of our cohort during follow-up. Overall, LM ostia cannulation was successful in 100% of the cases and we failed to cannulate 13.3% of RCA ostia. All PCI were successful with the need of a guiding cathteter extension in 44% of the procedures.

Adverse Events Associated with the Use of Guide Extension Catheters during Percutaneous Coronary Intervention: Reports from the Manufacturer and User Facility Device Experience (MAUDE) database.

We aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters. The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events. Of the 65 cases with reported GuideLiner-related issues, 15 (23%) involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the GuideLiner catheter, 38 (58%) involved GuideLiner catheter fracture, 9 (14%) involved coronary artery dissection, 2 (3%) involved coronary artery perforation, and 1 (1.5%) involved thrombus formation in the catheter. Of the 408 cases with reported Guidezilla-related issues, 53 (13%) involved inability to pass or damaged PCI devices into the Guidezilla catheter, 117 (29%) involved inability to advance the Guidezilla catheter to the target lesion, 59 (14%) involved kinked Guidezilla catheter, mostly because of partial or complete catheter fracture upon further investigation, 164 (40%) involved a broken Guidezilla catheter, 10 (2.5%) involved coronary artery dissection, 2 (0.5%) involved coronary artery perforation, 1 (0.2%)involved aortic dissection, 1 (0.2%) involved thrombosis formation, and 1 (0.2%) involved no-reflow phenomenon. Findings from the MAUDE database highlight the complications and modes of events associated with the use of GuideLiner and Guidezilla extension catheters. To assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters, the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried. There were more reports on Guidezilla-related events during the search period. The events for both extension catheters mainly involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the extension catheter, extension catheter fracture, coronary artery dissection and perforation and, occasionally, the death of the patients.

Clinical experience with 12-month follow-up in patients after implantation of a novel long-tapered sirolimus drug-eluting stent.

IntroductionLong lesions contribute to a significant number of percutaneous coronary interventions.AimTo assess the efficacy and safety of a novel long-tapered drug-eluting stent (DES) at a 12-month follow-up (FU) in patients with long coronary atherosclerotic lesionsMaterial and methodsA prospective clinical cohort study was conducted in 32 patients who underwent percutaneous coronary intervention using a BioMime Morph tapered stent (Meril Life Sciences, India). The patients were followed for 3, 6, and 12 months. The safety endpoints were death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and MACE and/or major bleeding.ResultsMean lesion length was 48 mm (range: 35–70 mm) measured via quantitative coronary analysis (QCA). In most cases, the target lesion was located in the LAD (68.75%). A GuideLiner catheter (Vascular Solutions Inc., MN, USA) was used in 12.5% of procedures; buddy-wire technique in 9.4% of cases. Bifurcation lesions were treated in 40.6% of cases. Additional stent implantation was needed in 56% of the procedures (25% of cases due to proximal or distal dissection, or due to insufficient stent length in 31% of cases). On 12-month FU we observed 1 TLR (3.1%), 1 TVR (3.1%), and 1 non-cardiovascular death.ConclusionsThe long sirolimus-eluting stent with tapered structure was characterized by good deliverability in long coronary lesions, although in some cases “buddy wire” or extension microcatheter use was necessary. Follow-up at 3, 6, and 12 months showed no significant major adverse cardiovascular events related to the device.

Zastosowanie techniki BaLloon Assisted Sliding and Tracking of GuideLiner (BLAST-G) do skutecznego umieszczenia stentu w zwapniałej zmianie o krętym przebiegu — opis przypadku

GuideLiner (Vascular Solutions Inc., USA), GuideZila (Boston Scientific, USA) and Heartrail (Terumo, Japan) are the guide extension or mother-in-child catheters, which enhances guide support and therefore ease device delivery in tortuous, calcified vessels. In cases when the GuideLiner catheter cannot be advanced even with balloon anchoring technique, we slided the GuideLiner over inflated semi-compliant at medium pressure, facilitating its tracking over the workhorse wire through tortuous and balloon anchoring technique. Here, we describe a technique called BaLloon Assisted Sliding and Tracking of GuideLiner (BLAST-G) to successfully deliver the stent in proximal left anterior descending artery in a 73-year-old female patient suffering from chronic stable angina.

Anchor-balloon technique to facilitate stent delivery via the GuideLiner catheter in percutaneous coronary intervention.

The GuideLiner (GL) is a widely used catheter primarily in complex percutaneous coronary intervention (PCI). Deep seating of the GL and distal stent placement may be facilitated by the anchor-balloon technique (ABT). We aimed to prospectively analyze procedural details, technical success, complications and in-hospital outcome in patients who underwent PCI using the GL catheter and the ABT. A total of 118 patients underwent PCI with the aid of the GL and ABT. Procedure success rate was 95% (112/118) and only seven patients (5.9%) encountered complications. ABT was indicated and successfully used in 29 patients (25%). GL and ABT successfully aided stent delivery in unfavorable and heavily calcified lesions which otherwise may have been considered unsuitable for PCI.

The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion

BackgroundFailure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use. MethodsWe examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. ResultsAlmost all lesions were classified as severely calcified (94.4±0.24%). The Japanese CTO score reflecting lesion complexity was 3.56±0.78. All procedures were performed femorally; the retrograde approach was used in 27.8±0.46% of cases. The overall success rate was 88.9±0.32%; there were no relevant complications. ConclusionsThe GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible.

A helping hand: GuideLiner use to facilitate stent delivery.

The GuideLiner catheter system is a tool that can be used to increase procedural success in complex percutaneous coronary intervention. The safety profile of the device has improved with successive generations and with increased operator experience. Methods to utilize the GuideLiner safely and effectively are described in this article.

Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention.

Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system. There is paucity of data about the efficacy of this device in complex PCI. Therefore, we aim to report the indications, success, and efficacy of GuideLiner use in treating complex lesion subset in the present study. We collected data from all patients in whom the GuideLiner was used to facilitate PCI between April 1, 2011 and December 31, 2014 at a tertiary referral center in Toronto, Canada. Demographic and procedural data were obtained from an institutional prospective data registry. Indications for use of the GuideLiner, and angiographic and procedural data specific to the device were also collected. The GuideLiner was utilized in 307 (317 lesions) of 6105 PCI procedures performed at our institution during the study period. The mean age was 68.4 ± 11.2 years and 82% were male. The majority of lesions were types B2 or C (98%), calcified (86.3%), with proximal tortuosity (88.6%). The overall technical success rate of the GuideLiner was 88%. The procedural success rate was 98.7%. The complication rate was low (1.6%). Use of the GuideLiner catheter facilitated successful completion of PCI procedures in a majority of patients with complex lesions. Operators should be aware of the potential complications associated with GuideLiner use.

Performance of the XLIMUS Sirolimus‐Eluting Coronary Stent in Very Complex Lesions

Stent delivery failure may occur especially when treating complex coronary artery stenosis. XLIMUS (CARDIONOVUM GmbH, Bonn, Germany) is a new sirolimus-eluting stent (SES) with the following features: 1) cobalt chromium stent platform, with low (73 μm) strut thickness, (2) biodegradable polymer, and 3) potent antiproliferative drug (Sirolimus). Preliminary data suggest that XLIMUS SES may be ideal for the treatment of complex lesions. In this registry, we assessed the deliverability, safety, and efficacy of percutaneous coronary interventions (PCI) using the XLIMUS SES in patients undergoing elective PCI in native coronary vessels for complex de novo lesions, including severe calcification, severe tortuosity, and chronic total occlusion. The primary objective of the study is the delivery success of the XLIMUS SES. The secondary objective is the 1-year rate of major adverse cardiac events (MACE; including all-cause death, nonfatal myocardial infarction, and repeat revascularization). A total of 200 consecutive patients with 255 lesions were included. Delivery success was obtained in 196 (98%) patients and in 251 (98.4%) lesions. The XLIMUS SES was successfully implanted on the first attempt with a single guidewire in 176 (88%) patients and in 208 (81.6%) lesions. Additional techniques to facilitate stent delivery (i.e., buddy wire, anchoring-balloon, or GuideLiner catheter) were necessary in 47 (18.4%) lesions. Failure in XLIMUS SES implantation occurred in 4 (1.6%) lesions. MACE rate at 1 year was 9%. This registry supports the positive performance of the XLIMUS SES in the treatment of complex coronary artery lesions.

Innovative use of a guideliner catheter to assist in snare retrieval of an entrapped kinked guide catheter during transradial coronary intervention

Rescue techniques that enable removal of severe intravascular catheter kinking are always worthwhile. We herein demonstrate the novel employment of a GuideLiner support catheter to assist in the removal of a kinked and entrapped guide catheter within the radial artery during coronary intervention. © 2016 Wiley Periodicals, Inc.

Use of the GuideLiner Catheter to Support Complex Coronary Intervention Using Transradial Access

Use of the GuideLiner Catheter to Support Complex Coronary Intervention Using Transradial Access

TCTAP C-031 The Superiority of a 5.5-French GuideLiner Catheter for Stent Delivery Compared to a 6-French One

TCTAP C-031 The Superiority of a 5.5-French GuideLiner Catheter for Stent Delivery Compared to a 6-French One

TCTAP C-160 The Effective Use of GuideLiner Catheter for Heavily Calcified and Tortuous Just Proximal Left Anterior Descending Intervention

### Patient initials or identifier number 114850 ### Relevant clinical history and physical exam An 87-year-old man admitted to our hospital with effort angina pectoris for one month. He had many risk factors hypertension, dyslipidemia, current smoking, diabetes mellitus, chronic kidney disease,

GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of a Single Coronary Trunk Arising from the Ascending Aorta.

Cases in which an anomalous single coronary trunk arises from the ascending aorta are extremely rare. In percutaneous coronary intervention for the lesion of a coronary artery anomaly, several problems may occur, including selection of a guide catheter, insufficient backup force, and difficulties of stent delivery. The GuideLiner catheter, which is a coaxial guide extension having the advantage of rapid exchange, facilitates coronary intervention for complex lesions. We report a case of angina having a lesion in the left anterior descending artery of a single coronary trunk arising from the ascending aorta. We successfully performed revascularization by using the GuideLiner catheter.

Extended use of the GuideLiner in complex coronary interventions.

Challenging coronary anatomies including chronic total occlusions (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries pose difficulties in coronary interventions. The GuideLiner is a monorail catheter originally developed to facilitate delivery of stents to target lesions in tortuous vessels. We conducted a study on the feasibility and safety of utilising this catheter in a wider array of complex coronary interventions. Consecutive patients undergoing coronary or peripheral interventions where a GuideLiner was used were recruited into this study. Patient demographics, lesion and vessel characteristics, procedural details and outcomes were prospectively entered into our database and analysed. From September 2009 to October 2011, 54 consecutive patients underwent coronary intervention in our institution using a GuideLiner; 21 out of 54 coronary applications were motivated by the need to increase support to cross CTOs, predominantly of the RCA. Anomalous or angulated take-off of the treatment vessels (31%), previously deployed proximal stents (15%), heavy proximal calcification (9%) and tortuosity (7%) accounted for the remaining reasons. One patient had successful renal denervation with the aid of a GuideLiner catheter. Procedural success was 98% in our series with no device-related periprocedural complications such as ostial dissection or myocardial necrosis. The use of a GuideLiner facilitates the approach to complex coronary interventions including chronic total occlusion and saphenous vein graft intervention by providing greater back-up support and easier engagement of coronary ostia.

GuideLiner catheter application in complex coronary lesions: experience of two centers.

Objective:GuideLiner catheter provides adequate back-up support and a coaxial guide engagement for stent delivery in complex coronary anatomies. In this study, we aimed to present one of the largest series of experience with GuideLiner catheter utilized for challenging percutaneous coronary interventions in two centers.Methods:We retrospectively collected the coronary angiography records of 64 patients between January 1, 2012 and August 1, 2014 in whom conventional techniques failed for stent delivery and 5-in-6 Fr GuideLiner catheter was used for this purpose. The data were assessed in terms of the lesion characteristics, procedural success, and complications. Descriptive statistics and frequencies were used in statistical analyses.Results:The mean age of the patients was 69.8±10.0 years. Femoral approach was employed in all cases. Lesions were mostly (90.6%) class B2 or C according to the AHA/ACC lesion classification. The GuideLiner catheter was mainly used to increase back-up of the guide catheter (85.9%), and in 95.3% of all cases, the procedure was successful. The mean depth of the GuideLiner catheter intubation was 30.3±21.6 mm. None of the patients had coronary dissection or major complications.Conclusion:In this study, we presented a large registry of two centers used the GuideLiner catheter. The device effectively allowed stent delivery in challenging lesions, where conventional techniques have failed, without major complications.

TCTAP C-125 Severe Tortuous RCA PCI Successfully Treated by Using Guideliner Catheter

TCTAP C-125 Severe Tortuous RCA PCI Successfully Treated by Using Guideliner Catheter

TCTAP C-079 The Utility of the Guideliner Catheter in Coronary Intervention of a Chronic Total Occlusion

### Patient initials or identifier number Two cases (335312 and 331056) ### Relevant clinical history and physical exam Case1: The patient was a 62-years-old-male who was previously performed coronary intervention for RCA. He presented with increased exertional angina symptoms. His coronary risk