` GUIDELINER® CATHETER
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`GuideLiner Catheter Used for
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`Proximal to Distal Stent Technique
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`PHYSICIAN
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`Steven S. Roh, MD, FACC
`North Memorial Heart and Vascular Institute
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`Robbinsdale, Minnesota
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`PRESENTATION
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`A patient was admitted to the hospital with refractory Canadian
`Class IV angina. He had undergone a previous five vessel CABG in
`1997 and was studied by angiography six months earlier. On his
`previous study, he had native three vessel coronary artery disease.
`His LIMA to LAD, SVG to diagonal, and SVG to PDA were patent. His
`posterior and lateral walls were vulnerable to ischemia due to his
`occluded sequential SVG to the OM and posterolateral branches.
`He was treated with medical management but continued to have
`life limiting angina despite his maximum antianginal therapy. His
`angina continued to crescendo until his day ofadmission.
`In the
`week prior to his admission, he had taken up to twenty sublingual
`nitroglycerin tablets.
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`INITIAL FINDINGS
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`Coronary and graft angiography performed during the most
`recent admission was without change from the previous study.
`The patient had clearly failed medical therapy. The source of
`his ischemia was the posterolateral wall due to limited native
`flow from the RCA and limited retrograde filling from the SVG to
`the PDA. Angiography suggested that he would benefit from
`revascularization ofthe posterolateral branch of the RCA.
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`TREATMENT
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`The diagnostic angiogram of the RCA demonstrated a technically
`challenging PCI due to the numerous acute bends within the
`RCA, including the greater than 90° angle from the distal RCA to
`the posterolateral branch, and the severe diffuse disease within
`the entire RCA (Figure 1). Even the initial guide selection was a
`challenge due to the significant lesion in the ostial and proximal
`RCA. As a result, a 6F JR4 guide was chosen to cannulate the RCA
`to allow for the necessary guide manipulations. A 300cm ChoICE®
`PT guidewire was advanced into the distal PLA. The lesion in the
`distal RCA/proximal PLA was predilated (with great difficulty) with
`a 1.5 x 20mm OTW balloon (Figure 2). The first challenge in the
`case came from the deep seating of the guide catheter to provide
`the support for advancing the OTW balloon catheter across the
`chronically occluded distal RCA/proximal PLA branch.
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`With the necessary deep seating of the guide there was ulceration
`of the proximal RCA and acute vessel occlusion (Figure 3). To
`resolve this, the proximal RCA was stented.
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`(continued on back)
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`TREATMENT {QQMTENQEEEE
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`The fact that there were freshly laid stent struts in the proximal
`RCA ofthis tortuous vessel would have prevented delivery ofthe
`distal stents, especially within a 6 French system. Therefore, the
`GuideLiner was advanced past the freshly laid stent struts into
`the distal RCA. Then, using the GuideLiner and the guidewire as
`a ”rail’; the JR4 guide catheter was advanced into the mid RCA to
`provide greater backup for delivery of the distal coronary stent past
`the numerous acute angles. The GuideLiner was the pivotal tool
`needed to achieve the necessary backup and delivery ofthe distal
`stents into proximal and mid PLA. Following these manipulations
`and maneuvers, a 2.5 x 28mm PROMUS® drug-eluting stent
`was easily delivered to the proximal to mid PLA (Figure 4). A
`subsequent DES was delivered proximally through the GuideLiner.
`Once the stent was positioned, the GuideLiner was pulled back to
`”unsheath”the stent at the site ofthe lesion
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`(Figure 5). GuideLiner was the pivotal tool to achieve the
`successful percutaneous revascularization ofthis technically
`difficult vessel (Figure 6).
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`CONCLUSION AND POST PROCEDURE
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`Upon the three month follow up visit, the patient’s angina
`significantly improved so much so that the patient has resumed
`exercising on his treadmill and hasjust built a garage for his home.
`The GuideLiner catheter provided the necessary support to stay
`within a 6F guide system and successfully revascularize a highly
`tortuous, chronically occluded, distal RCA. First, the GuideLiner
`catheter provided the necessary ”rail” to successfully deep seat a
`guide catheter into the mid segment of the highly tortuous RCA.
`The GuideLiner catheter then provided the support necessary to
`deliver a "long" stent across a greater than 90° bend, in the distal
`segment ofa tortuous vessel. In summary, the GuideLiner is a novel
`tool to support stent delivery, which may be used to facilitate
`proximal to distal deployment or to "unsheath" a stent within a
`coronary lesion rather than pushing the exposed stent across the
`lesion.
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`Steven S. Roh, MD, FACC
`Steven S. Roh, MD, FACC has his ABIM Certification in
`lnterventional Cardiology and Cardiovascular Diseases
`as well as his CBNC Certification in Nuclear Cardiology.
`He attended medical school at Indiana University School
`of Medicine and his residency was at the University of
`Minnesota Hospital and Clinics. He studied Cardiology
`at Oregon Health Sciences University and lnterventional
`Cardiology at the University ofWisconsin. His specialties
`are lnterventional Cardiology, Nuclear Cardiology
`and General Cardiology. His current location is North
`Memorial Heart and Vascular Institute in Robbinsdale,
`Minnesota.
`
`
`
`GuideLinercatheters areintended to be used in conjunction with guide catheters to access discrete regions ofthe coronary
`and/or peripheral vasculature, and to facilitate placementand exchange ofguideWIres and other interventional devices.
`Pleasesee the lnstructionsfor Use fora complete listing ofthe indications, contraindications, warnings and precautions.
`CAUTION: Federal law (U.S.A.) restricts this deviceto sale by or on theorder of a physician.
`GuideLiner is a registered trademarkofVascularSolutions, Inc.
`All otliertrddemdrks and registered trademarks are property oftlieir respective owners.
`©2016VascularSolutions, Inc. All rights reserved. ML2369 Rev. B 10/16
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` SOLUTIONS
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`Page 2
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`Vascular Solutions, Inc.
`6464 Sycamore Court North
`Minneapolis, Minnesota 55369 USA
`Customer Service:
`United States: 888.240.6001
`International: (001) 763.656.4298
`customerservice@vasc.com
`www.vasc.com
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