A 4 x 23 mm stent was easily passed and deployed with an excellent angiographic result (see Figure 3). The lesion was predilated with a 1.5 x 15 mm balloon (see Figure 3). After deep intubation of the GuideLiner just proximal to the occlusion, and using a microcatheter (Finecross, Terumo, Japan), a GW (Fielder, Asahi Intecc, Japan) was successfully passed through the occlusion to the distal vessel. The GuideLiner catheter was inserted into the 6 Fr GC, to obtain better back-up support. The origin of the RCA was anomalous and difficult to engage with subsequent poor GC support and difficult GW manipulation (see Figure 3). PCI was performed through the right TRA using a 6 Fr Judkins Right (JR4.0, Launcher) GC, with the left TRA being used for contralateral injections. The decision was made to proceed with percutaneous coronary intervention (PCI) of the RCA. Subsequent cardiac magnetic resonance imaging (MRI) revealed inferolateral ischemia with viability in this territory. Coronary angiography revealed a chronic total occlusion (CTO) of the mid right coronary artery (RCA) with collateralisation from the left system. Cardiovascular risk factors included hypertension, dyslipidemia, and a history of smoking. Case Report Case OneĪ 53-year-old man presented with class two stable angina. In this report we show our first experiences of the GuideLiner catheter in two consecutive cases of chronic total occlusions of the right coronary artery in which the device was able to solve the technical difficulties associated with these complex procedures. This improves the back-up support and allows selective deep intubation in difficult coronary cases enabling easier balloon and/or stent crossing. After crossing the lesion with a conventional guide wire (GW), the GuideLiner is used as an inner catheter and inserted inside the 6 Fr GC, creating a mother-and-child system, and can be used to intubate the coronary artery. The GuideLiner™ (Vascular Solutions, Inc., Minneapolis, MN) (see Figure 1 and 2) catheter is a new coaxial mother-and- child guide extension. 7–11 Recently, the ‘mother-and-child’ technique, using a five-in-six system, has emerged as a powerful tool to increase back-up support. 6 A number of techniques have been used in order to try to improve the support. Owing to the smaller size of the radial artery, the choice of guiding catheter (GC) size is limited, with the maximal acceptable diameter being 6 Fr in the majority of cases and as a result back up support is compromised. It provides the additional benefits of earlier ambulation, a reduction in staff workload, and, most importantly, a reduction in the rate of access site complications, when compared with the transfemoral approach (TFA). The transradial approach (TRA) is emerging as a successful method for coronary intervention.
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