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`GUIDELINER® CATHETER
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`Successful Use of the GuideLiner
`
`Catheter to Treat Sequential
`Distal Carotid Artery Stenoses
`
`PHYSICIAN
`
`George Petrossian, MD
`St. Francis Hospital, Roslyn, New York
`
`PRESENTATION
`
`The patient is a male with a history of hypertension and
`hypercholesterolemia. He has a remote history of neck
`surgery for a parotid tumor, followed by radiation.
`
`Five months ago, he presented with a left hemispheric
`CVA, with moderate residual arm weakness. Angiography
`demonstrated a 50% ulcerated right internal carotid stenosis.
`The left carotid contained a proximal 90% stenosis at the
`origin, an 80% tubular mild left ICA stenosis distal to an
`angulated segment, and an 80% stenosis in the distal left ICA
`(petrous segment). At that time, an 8mm x 10mm, tapered
`Xact® stent was placed at the proximal stenosis with distal
`protection.
`
`Two weeks ago, the patient developed one hour of severe
`right arm weakness which resolved. He then underwent
`repeat carotid angiography.
`
`INITIAL FINDINGS
`
`Carotid angiography demonstrated a stable 50% ulcerated
`plaque within the right ICA. The left ICA proximal stent was
`widely patent. The mid left ICA contained an 80% tubular
`stenosis and the distal left ICA (petrous segment) had
`progressed and contained a 95% stenosis (Figure l).
`
`TREATMENT
`
`Without distal protection, a 3mm x 15mm balloon was used
`to perform PTA of the 2 distal stenoses (Figure 2). A 7mm x
`20mm Xact stent would not cross the distal lesion, and was
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`deployed at the more proximal lesion, with a similar 7mm
`x 20mm stent placedjust proximally. A significant residual
`stenosis was present at the distal stent margin as well as the
`most distal lesion in the petrous segment. Further attempts
`to cross the remaining lesions with a 2.0mm balloon over a
`0.014" guidewire were unsuccessful.
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`(continued on back)
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`Page 1
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`VSIQXM_EOOO44667
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`Teleflex Ex. 2189
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`Medtronic v. Teleflex
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`Page 1
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`Teleflex Ex. 2189
`Medtronic v. Teleflex
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`

`

`TREATMENT WITH GUIDELINER CATHETER
`
`A 0.014" BMW 300cm guidewire was placed distally in the
`left ICA and the GuideLiner catheter was advanced into the
`
`stented segment ofthe left ICA (Figure 3). A 2mm x 15mm
`OTW balloon crossed the distal lesion with GuideLiner
`
`support and a 300cm Wigglem guidewire was placed distally
`after removal of the BMW guidewire.
`
`A 3.5mm x 15mm bare metal stent and a 4.5mm x 18mm bare
`
`metal stent were deployed distally (Figure 4) within the left
`ICA and post dilated (Figure 5). The end result was a widely
`patent left ICA (Figure 6).
`
`CONCLUSION
`
`The GuideLiner catheter provided the support necessary to
`advance balloon and stent catheters to the distal left ICA
`
`in a patient with prior radiation, vessel tortuosity and prior
`stent implantation. Without the GuideLiner catheter, this
`procedure would have been unsuccessful.
`
`George Petrossian, MD
`Dr. Petrossian received his MD. from The
`Mount Sinai School of Medicine. He completed
`his Medical and Cardiology training at
`Columbia Presbyterian Hospital, New York
`and his Interventional Cardiology training at
`Massachusetts General Hospital. He is the
`Director of Interventional Cardiovascular
`Procedures, St. Francis Hospital,The Heart
`Center, Roslyn, NY.
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`GuideLinerCatheters areintended to be used in Conjunction with guide Catheters to aCCess discrete regions ofthe Coronary
`and/or peripheral vasculature, and to facilitate placementand exchange ofguideWires and other interventional devices.
`Pleasesee the lnstructionsfor Use fora complete listing nfthe indications, contraindications, warnings and precautions.
`CAUTION: Federal law (U.S.A.) restricts this deviceto sale by or on theorder of a physician.
`GuideLiner is a registered trademarkofVascularSolutions, Inc.
`All othertrademarks and registered trademarks are property oftheir respective owners.
`©2016Vascular$olutions, Inc. All rights reserved. ML1316 Rev. B 10/16
`
`Vascular Solutions, Inc.
`6464 Sycamore Court North
`Minneapolis, Minnesota 55369 USA
`Customer Service:
`United States: 888.240.6001
`International: (001) 763.656.4298
`
`customerservice@vasc.com S 0 L U 'I‘
`
`I U N S
`
`www.vasc.com
`
`Page 2
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`VSIQXM_EOOO44668
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`Teleflex Ex. 2189
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`Medtronic v. Teleflex
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`Page 2
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`Teleflex Ex. 2189
`Medtronic v. Teleflex
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`