GuideLiner Catheter Research Articles

Usefulness of GuideLiner Catheter during Percutaneous Coronary Intervention in Difficult to Cross Complex Lesions due to Calcification and Tortuosity

Failure of stent delivery during percutaneous coronary intervention is one of the common causes of procedural failure. The GuideLiner catheter is a novel device with rapid exchange characteristic that ease the device delivery in deep vessel. We are reporting four cases on the usefulness of the GuideLiner catheter during percutaneous coronary intervention to enable stenting in complex, calcified, tortuous or distal lesions.

Use of ‘Guideliner’ catheter to overcome failure of delivery of Absorb™ Bioresorbable Vascular Scaffold in calcified tortuous coronary lesions: Technical considerations in ‘Real World Patients’

In our series of 177 real world patients (223 lesions) who underwent Absorb Bioresorbable Vascular Scaffold (BVS) implantation, 78 lesions were calcified and tortuous lesions. In four of these, despite adequate lesion bed preparation, appropriate guiding catheter support and use of buddy wires, the BVS failed to track through the proximal calcified and tortuous coronary anatomy (CTCA). “Guide Liner” catheter (GLC) had to be finally used to resuccessfully deliver and implant BVS to the lesion site.We report for the first time four cases of use of guideliner catheter to successfully overcome failed delivery of BVS to the lesion site through proximal CTCA, calcified and tortuous coronary artery (CTCA) lesions treated with Absorb™ BVS. Because the BVS is a large profile device, certain difficulties were encountered in delivering it through the GLC, which were finally overcome. We have therefore discussed the ‘lessons and learnt’ and “salient practice points” to enable successful delivery of BVS through the GLC.

Recognition and Management of Incomplete Stent Expansion Facilitated by StentBoost and Guideliner Tools

Suboptimal or incomplete coronary stent expansion is associated with increased restenosis rate and target vessel revascularization. Stent visualisation with plain fluoroscopy has become challenging due to reduction of stent strut thickness. Inability of stent or balloon delivery is a frequent cause of procedural failures in percutaneous coronary interventions. This case report highlights the role of a novel stent enhancing technique, StentBoost, in recognition and management of incomplete stent expansion and of the Guideliner catheter, which is an essential assist device in complex and challenging coronary interventions, especially via the radial access.

Novel Use of the GuideLiner Catheter to Deliver Rotational Atherectomy Burrs in Tortuous Vessels.

Rotational atherectomy (RA) for heavily calcified lesions is essential for improved stent delivery and stent expansion. In tortuous vessels it is often difficult to advance the burr without rotation and possible injury to the endothelium of healthy vessel. The GuideLiner catheter, a child in mother catheter, has recently been used to allow for increased support for delivery of stents through tortuous vessels. We report a novel use of the GuideLiner for the delivery of an RA burr in tortuous vessels requiring increased guide support.

Use of guideliner cathater in saphenous vein graft: A case report

Guideliner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the complex coronary lesions. We describe the use of this device in a percutaneous intervention of a native diagonal lesion through tortious and calcific saphenous vein graft.

Transradial interventions with the GuideLiner catheter: Role of proximal vessel angulation

Transradial coronary intervention (TRI) is increasingly common, but anatomic variations and lack of guide catheter support may increase the complexity of TRI. The GuideLiner catheter (Vascular Solutions, Minneapolis,MN) is a guide catheter extension developed to provide increased guide catheter support. We hypothesized that TRI cases requiring GuideLiner support would have a greater proximal vessel angle and increased lesion angle tortuosity. This was a retrospective study reviewing 146 TRI cases performed at a single institution between August 2010 and June 2012. 22 cases (15%) required use of the GuideLiner support catheter. Procedural and angiographic characteristics of all cases were analyzed. Multivariable analysis and receiver operator curves (ROC) were used to analyze predictors of GuideLiner use. The indications for TRI were similar between both groups. Subjects who required use of the GuideLiner support catheter at the time of TRI were significantly older (69±12years vs. 62±13years, p=0.03). The proximal vessel angle was significantly greater in the cases requiring GuideLiner support (74°±35° vs. 37°±23°, p<0.001). Lesion angle in the Guideliner group was also significantly greater (48°±32° vs. 28°±25°, p<0.001). On multivariable analysis, proximal vessel angle independently predicted the need for GuideLiner support (AOR 1.4 per 10°, p<0.001). A 45° proximal vessel angle predicted the need for GuideLiner use with a sensitivity of 73% and specificity of 74% (c-statistic 0.79). None of the Guideliner TRI cases required conversion to femoral access. TRIs requiring GuideLiner catheter support had significantly increased lesion complexity and vessel tortuosity. Proximal vessel angulation is significantly associated with the need for GuideLiner use during transradial intervention. Use of the Guideliner facilitated successful completion of PCI despite the use of a wide variety of guiding catheters in this series.

GuideLiner Mother‐and‐Child Guide Catheter Extension: A Simple Adjunctive Tool in PCI for Balloon Uncrossable Chronic Total Occlusions

To investigate the use of the GuideLiner "mother-and-child" guide catheter extension system as a simple solution to facilitate initial device delivery in balloon uncrossable chronic total occlusions (CTOs) undergoing percutaneous coronary intervention (PCI). During PCIs for CTO lesions, an important reason for procedural failure is the inability to deliver a balloon or microcatheter across the lesion. We retrospectively accessed our interventional registry for 07/01/2010 to 03/21/2012 and extracted data on all CTO lesions involving GuideLiner catheter use. Cine review was performed to identify cases where a guidewire had crossed the CTO and the use of a GuideLiner catheter facilitated initial device delivery. We identified 28 patients that underwent PCI for CTO with a GuideLiner catheter used to assist initial balloon or microcatheter advancement across the culprit lesion. Mean overall CTO length was 26.3 ± 18.1 mm. The GuideLiner catheter was successful in delivering a small balloon to the CTO lesion in 85.7% of cases (24/28). A single CTO PCI resulted in a distal guidewire perforation, but there was no hemodynamic compromise or pericardial effusion and the patient was discharged the next day. Overall procedural success in these selected cases (where a guidewire had already crossed the CTO) was 89.3% (25/28). The GuideLiner mother-and-child catheter is a simple, safe and efficacious adjunctive device for difficult CTO PCIs where despite standard measures it is not possible to deliver an initial balloon or microcatheter across the occluded segment.

The GuideLiner®: an interventionist’s experience of their first 50 cases: “the mostly good, rarely bad, beware of the ugly!”

In the modern era of interventional cardiology, stent delivery failure in complex, tortuous and/or calcific coronary anatomy is encountered in approximately 5% of cases, leading to incomplete revascularization and procedural failure. The GuideLiner® catheter (Vascular Solutions, MN, USA) is a monorail guide catheter extension that facilitates safe and effective delivery of balloons and/or stents within challenging and complex coronary anatomy when conventional techniques have failed. It permits very deep intubation of the target vessel with coaxial alignment, thus providing effective backup support during the complex intervention. This article reports experiences with the GuideLiner in a series of 50 complex cases undertaken and/or supervised by one interventional cardiologist. We include a step-by-step description of the GuideLiner catheter delivery technique and effectively demonstrate its various clinical applications by way of illustrated case examples and practical ‘tips and tricks’ for optimal devic...

Left main coronary artery bidirectional dissection caused by ejection of guideliner catheter from the guiding catheter

The "Guideliner," a child catheter, aims to deliver stents in tortuous coronary lesions by deep engagement and providing better support. Coronary artery spiral dissection, which may be caused by deep-seated coronary catheters or noncoaxial engagement is one of the most seen percutaneous coronary intervention-related complications. In this case, Guideliner-related left main dissection occurred after successful revascularization of a chronic total occlusion at the left anterior descending artery and the left circumflex, which has not been previously reported. The Guideliner catheter is efficient in treating complex coronary lesions, but one should be aware of its related complications.

Guide catheter extensions: where are they taking us?

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

Usefulness and safety of the GuideLiner catheter to enhance intubation and support of guide catheters: insights from the Twente GuideLiner registry

Optimal ostial seating and adequate back-up of guide catheters are required for challenging percutaneous coronary interventions (PCI). The GuideLiner™ (GL) (Vascular Solutions Inc., Minneapolis, MN, USA) is a guide catheter extension system that provides active back-up support by deep coronary intubation. We aimed to assess feasibility and safety of GL-use in routine clinical practice. We prospectively recorded patient and procedural details, technical success, and in-hospital outcome of 65 consecutive patients undergoing "5-in-6" Fr GL-facilitated PCI of 70 target vessels. The GL was mainly used for PCI of complex coronary lesions: 97% (68/70) had American Heart Association/American College of Cardiology (AHA/ACC) lesion types B2/C; 53% (37/70) were distally located; and 23% (17/70) were heavily calcified. Indications were to increase back-up of the guide and facilitate stent delivery (59%; 41/70), achievement of coaxial alignment of the guide catheter (29%; 20/70), and selective contrast injections (13%; 9/70). Device success rate was 93% (65/70). There were no major complications and two minor complications managed without clinical sequelae: one air embolism and one stent dislodgement. GL-use resulted in increased back-up and guide catheter alignment for stent delivery in unfavourable tortuous coronary anatomies and complex, heavily calcified, and often distally located lesions, which otherwise may have been considered unsuitable for PCI. Procedural success rate was high and there were no major complications.

Transfemoral use of the guideLiner catheter in complex coronary and bypass graft interventions

The GuideLiner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange catheter that allows deep vessel intubation. We describe 21 patients in whom the GuideLiner catheter [7 French (F) in 76% and 6F in 24%] was used to facilitate equipment delivery (n = 14) or vessel engagement (n = 7). Pressure dampening after GuideLiner catheter insertion was observed in 12 patients (57%). The procedure was successfully completed in 19 patients (90%) and one patient developed acute vessel closure, likely due to dissection. The GuideLiner catheter can facilitate complex coronary interventions but should be used with caution to minimize the risk for vessel injury.

Novel use of the guideLiner catheter to minimize contrast use during PCI in a patient with chronic kidney disease

The GuideLiner catheter (Vascular Solutions, Minneapolis, MN) is a rapid-exchange "mother and child" guide extension that increases support in complex percutaneous coronary intervention (PCI). While this device was primarily designed to facilitate balloon and stent delivery, we describe the use of this device to reduce contrast volume through sub-selective visualization in a patient with chronic kidney disease (CKD) undergoing PCI of the left coronary system.

Guideliner® catheter—Friend or foe?

Performing percutaneous coronary intervention (PCI) in arteries with complex anatomy remains a clinical problem. In particular tortuosity within a coronary vessel is frequently encountered and can hamper delivery of balloons or stents to coronary stenoses. This has led to the development of a number of adjuvant devices to assist stent delivery in difficult cases. The safety profile of these novel devices remains to be clearly ascertained. The Guideliner "child" support catheter is one such device and comprises of a 20-cm silicon-coated guide extension that assists delivery of stents in tortuous arteries when conventional techniques have failed. Initial reports suggest it is efficacious and no previous complications relating to the device have been published. We report the first complication involving the Guideliner catheter which was encountered during primary PCI. We hypothesize regarding the mechanism of the complication and discuss the ways it may be avoided in the future.

The Guideliner™ Catheter for Stent Delivery in Difficult Cases: Tips and Tricks

Stent delivery in complex coronary anatomy with severe calcification and tortuosity is still a common cause of percutaneous coronary interventions (PCI) failure. Recently, a new support rapid exchange catheter, the Guideliner, has been designed specifically for device delivery. From June 2010 to December 2010, we performed 10 cases using the Guideliner catheter to improve backup support and facilitate stent delivery: 2 emergent PCI for ST elevation myocardial infarction, and 8 stable elective PCI. In 3 cases the operator chose the femoral access, in 2 cases crossover from radial to femoral access was needed, and the other cases were performed radially. In 2 cases PTCA with drug-eluting balloon was performed; in the other cases second-generation drug-eluting stent was implanted. One case, the first one, failed, as stent could not be delivered to the target lesion. The other 9 cases were performed successfully. Three proximal dissections were detected and sealed with stent implantation. In 2 cases, we had stent damage due to the passage of the stent through the Guideliner metal collar. Another stent had to be used. In our experience, the Guideliner catheter is safe to use and helps device delivery in difficult settings. We describe here our experience with the Guideliner catheter for stent delivery and backup support; we discuss its utility and drawbacks in acute and stable clinical settings. Moreover, the aim of this article is to help interventional cardiologists using the device in difficult lesions to avoid potential complications.

Use of the GuideLiner catheter in facilitating coronary and graft intervention

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. 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. 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. 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'. Recently, several such catheters have become commercially available, including Terumo's Heartrail II catheter and Vascular Solutions' GuideLiner catheter.

Distal stent delivery with guideliner catheter: First in man experience

Failure to deliver stents is one of the commonest causes of procedural failure in contemporary PCI practice. We describe successful use of the Guideliner catheter, the first purpose designed FDA and CE marked device delivery catheter in 13 complex cases in native coronary vessels and bypass grafts performed via the radial route to enable distal stent delivery following failure of conventional techniques. We discuss how the Guideliner catheter may be used to facilitate difficult radial cases.