`
`GUIDELINER® CATHETER
`
`Successful Distal Stent Delivery Past Multiple Previous Stents
`Made Possible by the GuideLiner Catheter
`
`
`
`PHYSICIANS
`
`Binita Shah, MD
`
`Chad Kliger, MD
`John Coppola, MD
`New York University Medical Center, New York
`
`PRESENTATION
`
`The patient is a male with a history of diabetes mellitus,
`hyperlipidemia, hypertension and coronary artery 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 angiogra phy confirmed a 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 advance a stent to the distal
`lesion were unsuccessful, despite the use ofa Wiggle“
`guidewire for buddy wire support. The procedure was
`completed with balloon dilation only.
`
`Page 1
`
`(continued on back)
`
`VSIQXM_EOOO44665
`
`Teleflex Ex. 2192
`
`Medtronic v. Teleflex
`
`
`Page 1
`
`Teleflex Ex. 2192
`Medtronic v. Teleflex
`
`

`

`
`
`SUBSEQUENT TREATMENT OF 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 advance to the lesion through the
`GuideLiner. A 2.5mm x 12mm Sprinter® balloon was placed
`at the distal lesion and inflated. With the distal anchor
`
`SUMMARY
`
`balloon inflated, the GuideLiner was advanced into 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 was achieved (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 of this difficult
`and persistent distal lesion.The GuideLiner enabled deep
`seating within a vessel, even past previous stents and
`atherosclerotic plaque.
`
`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
`
`nu 5
`
`in
`ii
`1.-
`,It.‘I"-
`2*
`r
`
`
`VaSbUIar
`SOLUTIONS
`
`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 nfthe 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, lnc.All rights reserved.ML1281 Rev. B 10/16
`
`Page 2
`
`VSIQXM_EOOO44666
`
`Teleflex Ex. 2192
`
`Medtronic v. Teleflex
`
`
`Page 2
`
`Teleflex Ex. 2192
`Medtronic v. Teleflex
`
`