`
`
`GUIDELINER® CATHETER
`
`
`
`Successful Multi-Stent Delivery
`in H avily Calcified Ri ht
`Coronary Artery Using the
`GuideLiner Catheter
`
`PHYSICIAN
`
`Patrizia Presbitero, MD
`
`Chief of Interventional Cardiology Department
`Hospital Humanitas Rozzano—Milano
`
`PRESENTATION
`
`The patient is a male, with a relevant medical history
`consisting ofdiabetes mellitus, hypertension and
`hyperlipidemia. Three years prior to this visit the patient
`presented with acute coronary syndrome and underwent
`PCI with rotablation and stenting ofthe LAD. At that time,
`treatment of a stenosed, heavily calcified right coronary artew
`was also attempted with rotablation and POBA, but it was
`impossible to position the stent due to the tortuosity and
`calcification ofthe 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 ofa 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 NP (Figure 1). Left ventricular
`function was preserved.
`
`TREATMENT
`
`A 7F amplatz left guiding catheter was positioned at the
`ostium of the right coronary artery. After positioning two
`Balance Heavyweight 0.014" guidewires in the NP 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
`
`(Figure 2).
`
`(continued on back)
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`GUIDELINER SUPPORTED TREATMENT
`
`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 kept inflated, acting as an
`anchor so that the GuideLiner catheter could be pushed
`over the balloon and positioned right in front of the distal
`lesion (Figure 3). After removing the balloon, 3.5mm x 12mm
`and 3.5mm x 15mm XienceTM 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 Xience stent 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.
`
`
`
`Patrizia Presbitero, MD
`
`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 othertrademarks and registered trademarks are property oftheir respective owners.
`©2016VascularSolutions, Inc. All rights reserved. ML1309 Rev. B 10/16
`
`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 S 0 L U 'I‘
`
`I U N S
`
`www.vasc.com
`
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