Novel Use of a GuideLiner Catheter to Visualize Distal LAD After LIMA Anastomosis in...
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`Novel Use of a GuideLiner Catheter to Visualize
`Distal LAD After LIMA Anastomosis in Selective
`Coronary Angiography
`
`By hmpeditor
`Created 01/31/2012 - 14:02
`February 2012 [1]
`Novel Use of a GuideLiner Catheter to Visualize Distal LAD After LIMA
`Anastomosis in Selective Coronary Angiography
`
`• Tue, 1/31/12 - 2:02pm
`• 0 Comments
`•
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`Section:
`Online Exclusive
`Issue Number: Volume 24 - Issue 2 - February 2012 [2]
`Author(s):
`
`Asif Serajian, DO
`
`ABSTRACT: We report a case of GuideLiner catheter use during transradial intervention for selective coronary
`angiography of the distal left anterior descending artery (LAD), beyond the left internal mammary artery (LIMA)
`anastomosis. The lesion within the LAD was located distal to the anastomosis of a very tortuous LIMA, otherwise
`unable to be visualized due to competitive flow from the LIMA. Stenting by way of the LIMA could not be
`performed due to this severe tortuosity as well. Alternatively, performance of the intervention without GuideLiner
`assistance would have required dual access, with injections both through the LIMA graft and the native LAD for
`angiography and intervention. Use of the GuideLiner served the purpose of selective LAD angiography to
`visualize the lesion, as well as delivery of the stent through a proximally calcified LAD. Using this single transradial
`route allowed the intervention to be completed, while reducing complications due to multiple access sites.
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`J INVASIVE CARDIOL 2012;24(2):E30-E31
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`_________________________________
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`The GuideLiner catheter is a “mother-and-child” guide extension intended to provide extra support needed for
`balloon or stent delivery. It can be placed over an exchange length (300 cm) or 180 cm guidewire because it is a
`rapid exchange 145 cm device with a stainless steel shaft and 20 cm single lumen catheter.
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`[3]Transradial intervention enables early ambulation, as well as reduced access site complications
`from percutaneous coronary intervention (PCI).1-3 However, meta-analysis shows that there is an
`increased crossover rate to a transfemoral approach, as well as increased fluoroscopic time with the
`transradial route.4 With the introduction of the GuideLiner catheter, it is possible that some of this
`crossover can be reduced.
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`Case Report
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`[4]We report a 76-year-old male patient with a previous history of hypertension,
`hypercholesterolemia, diabetes mellitus, and ischemic cardiomyopathy. The patient has an
`automatic implanted cardioverter-defibrillator and coronary artery bypass grafting (LIMA to LAD,
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`Novel Use of a GuideLiner Catheter to Visualize Distal LAD After LIMA Anastomosis in...
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`saphenous vein graft to right posterior descending artery, and saphenous vein graft to diagonal
`branch). He presented with symptoms of angina and an abnormal stress test that demonstrated a
`large anterior wall defect. Coronary angiography was performed by his attending cardiologist, and illustrated a
`90% stenosis of the LAD after a tortuous LIMA. The LIMA was only visualized after selective angiography due to
`competitive flow during native coronary angiography. The saphenous vein graft to the posterior descending artery
`was patent. The patient had renal insufficiency and was scheduled to return for an intervention of the LAD lesion.
`
`[5]After a review of the angiographic images, we determined that the lesion in the LAD could not be
`visualized during native left coronary angiography (Figure 1). PCI of the LAD could not be
`performed through the LIMA due to its severe tortuosity (Figures 2 and 3).
`
`The initial plan was to obtain dual access for LIMA angiography and LAD intervention. This would
`obviously increase the chance of access site complication and add to the complexity of seating a
`catheter in the LIMA with dual injections.
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`[6]Instead, a right radial approach was used for the intervention. An Ikari Left 3.75 guide catheter
`(Terumo) was utilized along with a GuideLiner for selective LAD angiography. This allowed for
`superior visualization of the LAD lesion (Figures 4 and 5), and facilitated stent delivery through a
`calcified proximal LAD. A Runthrough™ NS wire (Terumo) was used to cross the lesion. Difficulty in-
`stent advancement though the native proximal LAD was encountered, and therefore predilation was
`performed. A 3.0 x 15 mm Xience V stent (Abbott) was deployed. Excellent angiographic results followed (Figure
`6), and the patient was discharged the next day without any access site complications or rise in serum creatinine
`level. The case was converted from complex to straightforward.
`
`Discussion
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`[7]The GuideLiner catheter is a new device in the coronary interventional field that has been used for
`assistance with device delivery. Usually, it has been used as a “bail-out” device if a stent cannot
`cross. As the device is a guide extension, it selectively intubates the coronary artery. This specific
`property was utilized in this case to visualize a lesion in the LAD that was not seen due to
`competitive flow from the LIMA. This simplified the procedure for the patient, and reduced the risks
`associated with multiple access sites.
`
`[8]Although the GuideLiner catheter was useful in this case for selective coronary angiography, one
`must be cautious while advancing this catheter into coronary arteries. There is an inherent risk of
`plaque disruption, which could lead to vessel dissection. Acknowledging this, the GuideLiner is still
`a valuable tool in the field of interventional cardiology.
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`Conclusion
`
`The GuideLiner catheter can be used for selective LAD angiography in cases where there is competitive flow from
`the LIMA present.
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`References
`
`1. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation.
`Catheter Cardiovasc Diagn.1993 Oct;30(2):173-178.
`2. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography
`or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-
`analysis of randomized trials. Am Heart J. 2009 Jan;157(1):132-140.
`3. Vorobcsuk A, Kónyi A, Aradi D, et al. Transradial versus transfemoral percutaneous coronary intervention in
`acute myocardial infarction systematic overview and meta-analysis. Am Heart J. 2009 Nov;158(5):814-821.
`4. Saito S, Miyake S, Hosokawa G, et al. Transradial coronary intervention in Japanese patients. Catheter
`Cardiovasc Interv. 1999 Jan;46(1):37-41;discussion 42.
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`_________________________________
`
`From the Department of Cardiology, West Suburban Medical Center, Oak Park, Illinois.
`Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of
`Interest. The authors report no conflicts of interest regarding the content herein.
`Manuscript submitted June 21, 2011, provisional acceptance given July 18, 2011, final version accepted July 27,
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`2011.
`Address for correspondence: Asif Serajian, DO, FACC, 1000 W Adams, #603, Chicago, IL, 60607. Email:
`aserajian1@gmail.com [9]
`
`[10]
`
`[11]
`
`Source URL: http://www.invasivecardiology.com/articles/novel-use-guideliner-catheter-visualize-distal-lad-after-lima-anastomosis-
`selective-coronar
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`Online Exclusive
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`Links:
`[1] http://www.invasivecardiology.com/issue/3141
`[2] http://www.invasivecardiology.com/content/volume-24-issue-2-february-2012
`[3] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%201.png
`[4] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%202.png
`[5] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%203.png
`[6] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%204.png
`[7] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%205.png
`[8] http://www.invasivecardiology.com/files/14%20Serajian_E30_Fig%206.png
`[9] mailto:aserajian1@gmail.com
`[10] http://www.invasivecardiology.com/printmail/3158
`[11] http://www.invasivecardiology.com/print/3158
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