`
`GUIDELINER® CATHETER
`
`GuideLiner Catheteris Useful
`Both for Support and to Minimize
`Contrast Load by Super-Selective
`Injections in a High-Risk Chronic
`Renal Failure Patient
`
`PHYSICIANS
`Dr. Paolo Danna
`Dr. Alessandra Dozio
`Sacco Hospital of Milan, Italy
`
`PRESENTATION
`
`Male presents with polycystic kidney disease and stage 4
`chronic renal failure; his cardiovascular history is significant
`for ventricular arrhythmia, syncope, hypertension and
`hyperlipidaemia.
`
`He was admitted to the hospital after a syncopal episode with
`post-traumatic renal and retroperitoneal hematoma, which
`was treated with selective embolization of the lower branch
`
`ofleft renal artery.
`
`Several complications occurred during hospitalization:
`progressive bleeding needing several transfusions, ventricular
`tachycardia (VT), acute pulmonary oedema and non-ST
`elevation myocardial infarction. An echocardiogram showed
`hypokinetic cardiomyopathy with severe reduction of ejection
`fraction (EF) and a mild-to-moderate mitral regurgitation.
`
`INITIAL FINDINGS
`
`After the stabilization of his hemodynamic state, the patient
`was brought to the cath lab, where coronary angiography
`showed a three-vessel disease. The RCA showedextensive
`
`disease and a small calibre, the LCx showed subcritical
`
`stenosis of the ostium and mid-segment and a severe lesion
`in its distal part involving the PDA, and the LAD exhibited
`focal proximal disease.
`
`TREATMENT
`
`The patient was treated via PCI through the right radial
`approach using a 6F guiding catheter. The angioplasty of the
`LAD was optimized with a NO-eluting stent.
`
`(continued on back)
`
`VSIQXM_E00044787
`
`Teleflex Ex. 2183
`
`Medtronic v. Teleflex
`
`
`
`Page 1
`
`
`Page 1
`
`Teleflex Ex. 2183
`Medtronic v. Teleflex
`
`

`

`
`
`TREATMENT WITH GUIDELINER
`
`The PDA wasstudied with a GuideLiner catheter (Figures 1, 2
`& 3) as the instrumentfor a selective and minimized injection
`of contrast media. Afterwards, the same system was used to
`support and stabilize the implantation of an everolimus-eluting
`stent (Figures 4, 5 & 6). FFR of LCx was > 0.8, so the vessel was
`not treated.
`
`AFTER PCI
`
`Renal function was unchanged(serum creatinine, 2.2 mg/100ml)
`during the whole post-procedural stay. ECG monitoring showed
`a reduction in ventricular ectopic activity and subsequent evalu-
`ation showed the absenceof active kidney bleeding.
`
`SUMMARY
`
`This case report shows an adjunctive advantageof the GuideLiner:
`minimization of contrast load in by super-selective coronary injec-
`tions, thereby potentially helping in preventing contrast-induced
`nephropathy.
`
`In our patient, the use of the GuideLiner system allowed the reduc-
`tion of the amount of contrast medium thanks to super-selective
`and optimized injection. This is potentially useful to preserve renal
`function in patients with chronic renalfailure or other kidney dis-
`ease undergoing angiographic procedures.
`
`It is also important to consider the benefit of this system in urgent/
`emergent coronary procedures and in patients without adequate
`preparation against contrast-induced nephropathy.
`
`The GuideLiner system improves the selective evaluation of coro-
`nary anatomy, supports the deliverability of stents, and optimizes
`the use of contrast medium by minimizingits total volume with a
`possible consequent reduction in adverse renal events.
`
`Dr. Paolo Danna
`
`Director, Cardiac Catheterization Laboratory, Ospedale
`Luigi Sacco, Milano,Italy.
`
`Fellow in Cardiology, Ospedale Luigi Sacco,
`
`Dr. Alessandra Dozio
`
`Milano, Italy.
`
`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 ofthe 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 trademark ofVascular Solutions,Inc.
`All other trademarks and registered trademarks are property oftheir respective owners.
`©2016 Vascular Solutions,Inc.All rights reserved. ML2682Rev. B 10/16
`
`ees
`Naas
`'
`Y x
`oe
`as
`SESE
`ascular
`SOLUTIONS
`
`Vascular Solutions,Inc.
`6464 Sycamore Court North
`Minneapolis, Minnesota 55369 USA
`,
`CustomerService:
`i
`:
`United States: 888.240.6001
`International: (001) 763.656.4298
`customerservice@vasc.com
`www.vasc.com
`
`Page 2
`
`VSIQXM_E00044788
`
`Teleflex Ex. 2183
`Medtronicv. Teleflex
`
`
`Page 2
`
`Teleflex Ex. 2183
`Medtronic v. Teleflex
`
`