` GUIDELINER® CATHETER
`
`Successful Transradial Use of
`the GuideLiner Catheter to
`Selectively Treat Severe
`Disease in the LAD
`
`facilitated accurate stent sizing and positioning.
`
`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 12-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 segmentof the artery anda
`long segmentof heavily calcified disease in the mid-LAD (Figure
`1). The LCX showed minimal disease and overall LV function was
`mildly impaired (VEDP 16mmtHg).
`
`TREATMENT
`
`The RCA was treatedsatisfactorily 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 predilatedserially 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 targetlesion.
`
`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
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`Interventional Cardiologist.
`
`TREATMENT (CONTINUED)
`
`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 deliver a 4.0 x 15mm Quantum™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 andis
`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 nowpractices at
`Royal Victoria Hospital in Belfast as a Consultant
`
`the Belfast Trust as a Consultant Interventional
`
`Colm Hanratty, MD, FRCPI
`Dr. Hanratty received his MD from Queen's
`University Belfast in Northern Ireland, UK
`followed bya fellowship at North Shore Hospital
`in Sydney, Australia. He now practices with
`
`Cardiologist.
`
`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. ML2212 Rev. B 10/16
`
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`Sees
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`feet
`
`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
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`VSIQXM_E00044657
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`Teleflex Ex. 2193
`Medtronicv. Teleflex
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`Page 2
`
`Teleflex Ex. 2193
`Medtronic v. Teleflex
`
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