` GUIDELINER® CATHETER
`
`Successful Distal Stent Delivery Past Multiple Previous Stents
`MadePossible by the GuideLiner Catheter
`
`PHYSICIANS
`
`Binita Shah, MD
`Chad Kliger, MD
`John Coppola, MD
`New York University Medical Center, New York
`
`PRESENTATION
`
`completed with balloon dilation only.
`
`The patient is a male with a history of diabetes mellitus,
`hyperlipidemia, hypertension and coronaryartery disease.
`He has undergone a four vessel coronary artery bypass
`grafting and has had multiple interventions on a saphenous
`vein graft to the Ramus, with implantation of bare metal and
`drug-eluting stents (Figure 1). He returned for treatment
`after developing disabling angina.
`
`INITIAL FINDINGS
`
`Coronary angiography confirmeda lesion at the distal stent
`edge, beyond multiple previously placed stents, within the
`vein graft, extending into the native vessel (Figure 2).
`
`TREATMENT
`
`The distal graft lesion was treated with balloon angioplasty.
`Multiple attempts made to advancea stent to the distal
`lesion were unsuccessful, despite the use of a Wiggle™
`guidewire for buddy wire support. The procedure was
`
`Page 1
`
`(continued on back)
`
`VSIQXM_E00044665
`
`Teleflex Ex. 2192
`Medtronicv. Teleflex
`
`
`Page 1
`
`Teleflex Ex. 2192
`Medtronic v. Teleflex
`
`

`

`
`
`SUBSEQUENT TREATMENTOF THE
`SVG WITH GUIDELINER SUPPORT
`
`Two months after the balloon angioplasty was performed,
`the patient returned with recurrent angina. The SVG to the
`Ramus was cannulated with an AL1 guide catheter. The
`GuideLiner was advanced through the guide catheter and
`a Prowater™ wire was advanceto the lesion through the
`GuideLiner. A 2.5mm x 12mm Sprinter® balloon was placed
`at the distal lesion andinflated. With the distal anchor
`
`SUMMARY
`
`balloon inflated, the GuideLiner was advancedinto the
`
`vein graft through the prior areas of stented graft that had
`given so much difficulty passing on the previous procedures
`(Figure 3). With the GuideLiner in place, a Promus® stent
`passed easily to the distal lesion and was successfully
`deployed at 18atm. A good angiographic result and
`positive patient outcome wasachieved (Figure 4).
`
`By allowing the delivery of a stent through a saphenous
`vein graft with multiple previous stent implantations, the
`GuideLiner made possible the treatment ofthis difficult
`and persistent distal lesion. The GuideLiner enabled deep
`seating within a vessel, even past previous stents and
`atherosclerotic plaque.
`
`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. ML2281 Rev. B 10/16
`
`a7
`
`aa
`
`a7
`
`aa
`
`an ae ce e
`
`ascular
`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
`
`VSIQXM_E00044666
`
`Teleflex Ex. 2192
`
`Medtronic v. Teleflex
`
`
`Page 2
`
`Teleflex Ex. 2192
`Medtronic v. Teleflex
`
`