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`GUIDELINER® CATHETER AND R350™ GUIDEWIRE
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`Contemporary Chronic Total
`Occlusion Percutaneous Coronary
`Intervention: GuideLiner Catheter
`and R350 Guidewire Facilitated
`
`Reverse-CART
`
`PHYSICIAN
`J. Aaron Grantham, MD, FACC, FSCAI
`Mid America HeartInstitute, Kansas City, MO
`
`PRESENTATION
`
`A male with inferior MI two years ago wastreated with
`primary PCI using a drug eluting stent deployed in the mid-
`right coronary artery (RCA). He presents now to his local
`cardiologist complaining of exertional shortness ofair for the
`preceding six months. Stress myocardial perfusion imaging
`demonstrated a large reversible defect in the RCA distribution
`involving 15% of the myocardium.
`
`INITIAL FINDINGS
`
`Coronary angiography revealed a chronic total occlusion
`(CTO) of the RCA beyond the previously deployed stent
`(Figure 1). Attempted percutaneous coronary intervention
`(PCI) with antegrade wiring was unsuccessful. The occlusion
`extended past the bifurcation into the RPLV and PDA. He was
`referred for retrograde CTO-PCI, using the hybrid approach’.
`
`TREATMENT
`
`The CTO of the RCA was approachedwith retrograde crossing
`through a septal collateral from the LAD first septal perforator
`(Figure 2) using the Corsair® microcatheter and a Sion®
`wire (both from Asahi-Intecc, Nagoya, Japan). Retrograde
`dissection and re-entry was performed using the reverse
`controlled antegrade and retrograde dissection technique
`(XCART, Figure 3). After balloon inflation on the antegrade
`wire (long arrow) the retrograde wire could not be passed
`into the antegrade true lumen. A GuideLiner catheter was
`advanced antegrade into the distal RCA over a wire and
`balloon (Figure 4).
`
`(continued on back)
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`VSIQXM_E00044654
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`Teleflex Ex. 2181
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` TREATMENT CONTINUED
`
`The GuideLiner was intubated (Figure 4, long arrow) with the
`retrograde wire (Confianza® Pro 12, Asahi-Intecc, Nagoya, Japan)
`via the Corsair (Figure 4, short arrow). The Corsair (Figure 5,
`short arrow) was then advanced into the GuideLiner (Figure
`5, long arrow) and the Confianza Pro 12 wire removed. An
`R350 guidewire was passed through the Corsair from the
`retrograde guide all the way out the antegrade guide and used
`for antegrade ballooning and stenting with rapid exchange
`gear. The RPLV branch could not be treated as the retrograde
`distal cap was ambiguous and could not be penetrated with
`retrograde wires. Final angiography revealed a large PDA with
`TIMI-III antegrade flow after deploying a 3.0 x 38mm long drug
`eluting stent in the distal RCA (Figure 6).
`
`CONCLUSION AND POST PROCEDURE
`
`The patient was dismissed the following day symptom free.
`
`SUMMARY
`
`Vascular Solutions, Inc. has developed a portfolio of useful
`devices when approaching patients with complex chronic total
`occlusions. This case demonstrates the utility of the GuideLiner
`in facilitating reverse CART when re-entry with the retrograde
`wire is difficult. The R350 guidewireis a stainless steel wire with
`a 0.013" diameter that can be used as an externalization wire
`
`through the Corsair channeldilator for retrograde CTO-PCI.
`
`REFERENCES
`
`‘Brilakis E.S., Grantham J.A., et al., (2012). J. Am. Coll. Card:
`Cardiovascularint., 5, 368-79.
`
`Saito S., (2008). Catheter and Cardiovascularinter., F1, 8-19.
`
`J, Aaron Grantham, MD, FACC, FSCAI
`Dr. Grantham is an Associate Professor of
`Medicine at the University of Missouri, Kansas
`City and an Interventional Cardiologist at Saint
`Luke's Mid America HeartInstitute.
`
`www.ctofundamentals.org.
`
`For more information on the Hybrid approach to
`CTO-PCI, Dr. Grantham suggests physicians visit
`
`GuideLiner catheters are intended to be used in conjunction with guide catheters to access discrete regions of the coronary
`and/or peripheral vasculature, and to facilitate placement and exchangeof guidewires and other interventional devices.
`Please see theInstructions for Use fora completelisting of the indications, contraindications, warnings and precautions.
`CAUTION:Federal law (U.S.A.) restricts this device to sale by or on the orderof a physician.
`GuideLineris a registered trademarkof Vascular Solutions, Inc. R350 is a trademarkof Vascular Solutions, Inc.
`All other trademarks and registered trademarks are property of their respective owners.
`©2016 Vascular Solutions,Inc.All rights reserved. ML2760 Rev. B 10/16
`
`
`
`SOLUTIONS
`
`Vascular Solutions,Inc.
`6464 Sycamore Court North
`Minneapolis, Minnesota 55369 USA
`CustomerService:
`United States: 888.240.6001
`International: (001) 763.656.4298
`customerservice@vasc.com
`www.vasc.com
`
`Page 2
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`VSIQXM_E00044655
`
`Teleflex Ex. 2181
`
`Medtronic v. Teleflex
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`Page 2
`
`Teleflex Ex. 2181
`Medtronic v. Teleflex
`
`