` GUIDELINER® CATHETER
`
`
`
`Successful Transradial Use of
`
`the GuideLiner Catheter to
`
`Selectively Treat Severe
`Disease in the LAD
`
`PHYSICIAN
`
`Mark Spence, MB BCh BAO Honours, MRCP (Edinburgh), MD
`Colm Hanratty, MD, FRCPI
`Royal Victoria Hospital, Belfast, Northern Ireland
`
`PRESENTATION
`
`A male patient presented with an acute coronary syndrome
`and uncontrolled atrial fibrillation.The patient has a medical
`history of hypertension and hyperlipidemia. He presented with
`Inferolateral ST depression on lZ-lead ECG; troponin level T 0.05.
`An echocardiogram showed asymmetrical septal hypertrophy
`and inferior hypokinesis.
`
`INITIAL FINDINGS
`
`Coronary angiography confirmed severe ostial disease in the
`RCA, extending into the proximal segment ofthe artery and a
`long segment of heavily calcified disease in the mid—LAD (Figure
`1).The LCX showed minimal disease and overall LV function was
`
`mildly impaired (LVEDP 16mmHg).
`
`TREATMENT
`
`The RCA was treated satisfactorily with a Liberté® 3.0 x 12mm
`bare—metal stent. Initial access to treat the LAD was obtained
`
`through the transradial approach using a 7F JL3.5 Asahi
`sheathless guide catheter. A 1.5mm Rotablator“ burr was used to
`modify the calcified LAD. The lesion was predilated serially with
`an Apex® 3.0 x 20mm balloon. Due to the friction encountered
`in the proximal LAD and guide catheter back out, a 3.0 x 38mm
`Taxus® stent could not be delivered to the target lesion.
`
`TREATMENT OF THE LAD
`
`WITH GUIDELINER SUPPPORT
`
`A 6F GuideLiner catheter was inserted over the in-place .014”
`guidewire and easily passed through the proximal lesion
`and into the mid—LAD (Figure 2). Selective contrast injection
`improved visualization of the target vessel (Figure 3) and
`facilitated accurate stent sizing and positioning.
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`The GuideLiner catheter was used to successfully deliver a 3.0
`x 38mm Taxus stent to the mid—LAD, which was subsequently
`overlapped with an additional 4.0 x 24mm Taxus stent
`proximally (Figure 4). The GuideLiner catheter was then used
`to delivera 4.0 x 15mm Quantumm balloon for post—dilatation
`stent expansion.
`
`CONCLUSION AND POST PROCEDURE
`
`There was a good angiographic end result (Figure 5),
`following stenting and post-dilatation. IVUS confirmed
`the stent was apposed and optimally sized and deployed.
`The patient was discharged well, without complication the
`following day and was asymptomatic at 8 week review.
`
`SUMMARY
`
`By overcoming resistance in the proximal LAD, the GuideLiner
`catheter enabled successful delivery of interventional
`equipment to the heavily calcified mid-vessel.
`
`The facility for selective contrast injection via the GuideLiner
`catheter into the target vessel improved visualization
`facilitating optimal stent sizing and placement with limited
`total contrast volume.
`
`
`
`Mark Spence, MB BCh BAO
`
`Honours, MRCP (Edinburgh), MD
`Dr. Spence received his MD from Queen's
`University Belfast in Northern Ireland, UK and is
`an Honorary Senior Lecturer at the University.
`Dr. Spence completed an interventional
`cardiology fellowship, specializing in Coronary
`and Structural Heart Disease, at Royal Jubilee
`Hospital in Vancouver, British Columbia, Canada.
`In addition, Dr. Spence completed a fellowship in
`Congenital Heart Disease Intervention at Royal
`Brompton Hospital and Guy's and St. Thomas’
`Hospitals in London, UK. He now practices at
`Royal Victoria Hospital in Belfast as a Consultant
`Interventional Cardiologist.
`
`Colm Hanratty, MD, FRCPI
`Dr. Hanratty received his MD from Queen’s
`University Belfast in Northern Ireland, UK
`followed by a fellowship at North Shore Hospital
`in Sydney, Australia. He now practices with
`the Belfast Trust as a Consultant Interventional
`
`Cardiologist.
`
`GuideLinercatheters areintended to be used in conjunction with guide catheters to access discrete regions ofthe coronary
`and/orperipheralvasculature, and tofacilitateplacementand exchange ofguidewrres and otherinterventionaldevices.
`Pleasesee the lnstructionsfor Use fora complete listing ofthe 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 otliertrademarks and registered trademarks are property oftlieir respective owners.
`©2016Vascular$olutions, Inc. All rights reserved. MLZZIZ Rev. B 101%
`
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`Vascular Solutions, Inc.
`6464 Sycamore Court North
`Minneapolis Minnesota 55369 USA
`'
`Customer Service:
`United States: 888.240.6001
`International: (001) 763.656.4298
`
`S 0 L U 'I‘
`I U N S
`VaSClflal‘
`
`www.vasc.com
`customerservice@va5c,com
`
`VSIQXM_EOOO44657
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`Teleflex Ex. 2193
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`Page 2
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`Teleflex Ex. 2193
`Medtronic v. Teleflex
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