The GL catheter is a simple, adjunctive coaxial monorail guiding catheter extension delivered through a standard guiding catheter. Procedural success was defined as recanalization of the CTO with a residual stenosis of <30% and restoration of thrombolysis in myocardial infarction grade-3 flow.Ī composite safety endpoint summarizing severe complications, such as cardiovascular mortality, vessel perforation, cardiac tamponade, myocardial infarction, and stroke, was evaluated for each patient. Only drug-eluting stents (DES) were implanted.Īfter PCI a standard antiplatelet regime was conducted. Complex lesions with an ambiguous proximal cap and poor distal target were attempted by retrograde approach. Coronary wiring started with tapered polymer soft tip guide wires and stepwise accelerated up to super-stiff guidewires (12-gauge wires) if necessary. The antegrade approach was used as the first step.
In this study, guiding catheter extensions of only 7-Fr and 8-Fr sizes were used. In all cases, contralateral injection of contrast fluid was performed to determine the length of the lesion and the quality of intercoronary collaterals. Heparin was given during the interventions guided by the activated clotting time (>300 seconds). PCI procedures were performed via the femoral route. Antegrade and retrograde CTO techniques were considered, and the procedures were performed in a standardized manner. Indications for inclusion were angina pectoris and/or a positive functional ischemia test by magnetic resonance imaging or transthoracic echocardiography in the territory of the occluded artery of more than 10%. The procedures were performed by two high-volume operators. In this retrospective study, we analyzed the data of 18 patients (14%) in whom the GL was applied to facilitate CTO-PCI if an alternative technique such as an anchor balloon or a buddy wire was not possible. The purpose of this study was to assess the feasibility and safety of the usage of the GuideLiner (GL) catheter (Vascular Solutions Inc., Minneapolis, MN, USA) extension system in complex PCI of CTO.Ī total of 130 CTO-PCI were performed in our center between 20. The Heartrail system (Terumo, Tokyo, Japan) is available in 5-Fr, 6-Fr, and, 7-Fr sizes. The Guidezilla (Boston Scientific, Natick, MA, USA) has a hydrophilic coating with a polymer-coated metal collar to facilitate device insertion and is only available in a 6-Fr size.
IMDS produces the Guidion (IMDS, Roden, Netherlands) catheter which has a more flexible atraumatic distal end. Various companies have implemented guiding catheter extensions in their portfolio to overcome the problem of a poor backup support. Additionally, the use of stiffer wires, the anchoring balloon technique, and deep intubation of the guiding catheter may be applied to improve the backup support. Regardless of the clinical setting, an enhanced backup provides one of the most important preconditions to ensure guide wire and balloon advancement and stent delivery, thereby enabling a successful percutaneous coronary intervention (PCI).
Ī strong and stable backup of the guide catheter is essential to advance guidewires, balloons, and stents over the lesion in highly calcified and tortuous vessels. If significant myocardial ischemia exists combined with clinical symptoms due to ischemia, recanalization is indicated left ventricular function can be improved, more invasive therapies like coronary artery graft surgery can be avoided at lower complication rates, and even the prognosis of the disease can be improved in suitable cases with both a short-term and long-term survival benefit. In experienced hands, reopening rates exceed 85%. Due to new interventional techniques and the use of further advanced sophisticated materials, success rates of CTO recanalization increased steadily in recent years. A CTO of a coronary artery can be identified in up to 30% among patients with a clinical indication for coronary angiography. Recanalization of chronic total occlusions (CTO) remains a challenge in interventional cardiology.
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