2. Guide catheter backing out
Backup achieved by contact As guide backs out –backup
with coronary osteum and aorta lost as guide comes away from
coronary osteum & aortic wall
JR4
3. Solutions
• Poor backup support guide anchor balloon
deep seating large bore guide
• Tortuousity support wire
buddy
wire
• Friction lesion preparation
lower profile
stent
Ballooning / buddy wire frequently only option without
changing guide
→ Guide catheter extension
use within 6F guide over wires already in place
8. How Guide catheter extension helps
1) ↑back up support
shape change
extra deep seating
2) Cross obstruction easier than a stent
more flexible / smoother
pulling down
3) Proximal to distal stenting
crosses deployed stents with ease
9. Extension ↑↑ force transmission
Shape modification Deep intubation ↑↑ Force
↑ contact aorta ↑ contact coronary transmission
bypass tortuousity
Improved coaxial
Amplatzing alignment
10. only
only
• 2cm intubation equates to 8F guide Takahashi CCI 2004
11. Balloon / stent delivery CTO
CCI in press 2010 Mamas Ordoubadi Fraser
33. Conclusion
• Stent (equipment ) delivery → overcome vessel /
lesion resistance
• Support guides, deep intubation often useful
• Guide extensions very useful
– ↑↑ force transmission
– cross obstructions easier than stents
– can be pulled down the vessel
– enable proximal to distal stenting
– very useful vein graft PCI
• Overcome limitations of poor guide support
• Get you out of trouble, enable procedures
otherwise not possible
34.
35.
36. Comparison
• Both highly effective, atraumatic
• Can use within standard guide in situ without moving wire
Heartrail
• Air embolism
• Removal often disturbs undocked wires
• Can only extent stent 8cm beyond tip
Guideliner
• Rapid exchange convenience
• No air embolism
• Large stents, stents on secondary wires catch at
metal collar – wire wrap