` GUIDELINER® CATHETER
`
`Successful Multi-Stent Delivery
`inaHeavily Calcified Right
`Coronary Artery Using the
`GuideLiner Catheter
`
`PHYSICIAN
`
`Patrizia Presbitero, MD
`Chiefof Interventional Cardiology Department
`Hospital Humanitas Rozzano-Milano
`
`PRESENTATION
`
`(Figure 2). (continued on back)
`
`The patient is a male, with a relevant medical history
`consisting of diabetes mellitus, hypertension and
`hyperlipidemia. Three years prior to this visit the patient
`presented with acute coronary syndrome and underwent
`PCI with rotablation and stenting of the LAD.At thattime,
`treatment of a stenosed, heavily calcified right coronary artery
`was also attempted with rotablation and POBA,but it was
`impossible to position the stent due to the tortuosity and
`calcification of the artery.
`
`Three years later, due to increasing exertional angina, he was
`reconsidered for coronary angiography and eventually PCI.
`
`INITIAL FINDINGS
`
`Coronary angiography demonstrated patency of the
`previously treated LAD,and a heavily calcified circumflex
`artery with occlusion of a small marginal branch. The
`dominant right coronary artery was tortuous and completely
`calcified all along its course. Critical stenoses were present in
`the proximal and mid-distal (tandem lesion) right coronary
`artery with diffuse disease of IVP (Figure 1). Left ventricular
`function was preserved.
`
`TREATMENT
`
`A7F amplatz left guiding catheter was positioned at the
`ostium ofthe right coronary artery. After positioning two
`Balance Heavyweight 0.014" guidewires in the IVP and PL,
`we attempted to pass a microcatheter to the distal vessel
`with the intent to place a Rotablator® guidewire that
`was impossible to advance otherwise. The maneuver was
`unsuccessful due to the failure to advance the microcatheter
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`After removing one of the guidewires, a 6F GuideLiner
`catheter was inserted over the remaining Balance
`Heavyweight guidewire and advanced to the proximal
`portion of the right coronary. It was then possible for a 2.5mm
`x 3.0mm balloon to reach the distal lesions and to dilate
`
`it. In order to deliver the stent, it was necessary to further
`advance the Guideliner catheter. In order to do so, a 3.0mm
`
`balloon was inflated distally and keptinflated, acting as an
`anchor so that the GuideLiner catheter could be pushed
`over the balloon and positionedright in front of the distal
`lesion (Figure 3). After removing the balloon, 3.5mm x 12mm
`and 3.5mm x 15mm Xience™ stents were advanced through
`the GuideLiner catheter, positioned and deployed in the
`middle distal right coronary (Figure 4). After withdrawing
`the GuideLiner catheter to a more proximal location, a 4mm
`x 12mm Xiencestent was positioned proximally (Figure 5).
`Final dilatation with 3.5mm and 4mm high pressure balloons
`was performed while using the GuideLiner catheter in order
`to position the balloon distally. Good results were obtained
`(Figure 6).
`
`CONCLUSION
`
`In this case, by enabling distal stent delivery within a heavily
`calcified vessel, the GuideLiner catheter made it possible to
`treat previously unreachable lesions.
`
` GUIDELINER SUPPORTED TREATMENT
`
`
`
`Patrizia Presbitero, MD
`
`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 trademark of Vascular Solutions,Inc.
`All other trademarks and registered trademarks are property of their respective owners.
`©2016 Vascular Solutions,Inc.All rights reserved. ML2309 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
`
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`Teleflex Ex. 2191
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`Teleflex Ex. 2191
`Medtronic v. Teleflex
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