Abstract
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.
The GuideLiner catheter ( Fig. 1 ) is a modified ‘child’ guide catheter (GC) which can be delivered through a standard GC, providing an extension for deep seating, added backup support, and coaxial alignment. It has a 20-cm, highly flexible, super soft rapid exchange section which facilitates its insertion and allows the use of standard length guidewires, balloons, or stents through an existing haemostatic valve. A GuideLiner reduces the internal diameter of the ‘mother’ GC by approximately 1F size; it is available in 6F, 7F, and 8F sizes.
We describe two cases of percutaneous coronary intervention (PCI) involving saphenous vein grafts (SVG) where use of a 6F GuideLiner facilitated the procedure by providing excellent GC support and superior target lesion visualization.
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Case 1
A 52-year-old male presented with an acute coronary syndrome (ACS). Coronary and graft angiography demonstrated a lesion immediately distal to the anastomosis of a SVG with a large obtuse marginal branch (OM). Although the lesion was well visualized via graft angiography ( Fig. 2 ), it was poorly visualized via native vessel angiography due to competitive flow from the graft ( Fig. 3 ). A decision was taken to approach this lesion via the native circumflex, rather than via the graft, because of a 90° angle between the graft and the OM. Excellent visualization of the lesion was obtained following deep intubation of the left circumflex with a 6F GuideLiner ( Fig. 4 ), which also offered robust GC support, enabling direct stenting of the lesion with a 3×12-mm Promus stent ( Fig. 5 ).
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