The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events. We aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters. The in-hospital stay was uneventful, and the patient was discharged after 3 days from the procedure on dual anti- platelet (ticagrelor and aspirin) therapy for 12. A Stentys (Stentys SA, Paris, France) stent (3.5-4.5 × 22 mm) was implanted with a good final angiographic result (Figure 3F). Regarding the proximal aneurysm, the decision to implant a self-expanding stent was taken, and the GuideLiner V2 catheter (Vascular Solutions Inc., Minneapolis, MN, USA) was removed. The GuideLiner V2 catheter (Vascular Solutions Inc., Minneapolis, MN, USA) permitted the delivery of three stents in the distal LCx. Then, the Runthrough guide wire (Terumo, Japan) was able to reach the distal LCx. The latter was carefully inserted into the guide catheter and advanced to the OM, allowing the delivery of the stent (3.5 × 12 mm) to its middle segment (Figure 3D). At this moment, it was decided to place a “5-in-6” Fr GuideLiner V2 catheter (Vascular Solutions Inc., Minneapolis, MN, USA) in order to improve the support. Balloon predilation was responsible for the deinsertion of the guide catheter from the left main, and stent advancement was not possible (Figure 3C). The back-up was poor despite the two guide wires into the OM (Figure 3B), and only non-selective injections were obtained. Laborious thromboaspiration was performed. A runthrough guide wire (Terumo, Japan) was laboriously advanced into the first OM, while a second wire proved impossible to be advanced to the distal LCx (Figure 3A). A 6-Fr EBU 3.5 (Cordis Co., USA) was engaged in the left main. Intravenous Bivalirudin was administered. Because of the right subclavian tortuosity and poor back-up, a switch to 6-Fr right femoral access was decided. The left anterior descending (LAD) did not show any significant lesion, while the right coronary artery (RCA) was a minor diseased vessel (Figure 2). Additionally, the distal LCx was diseased with aneurysmal dilation, and the middle segment of the first obtuse marginal (OM) presented a tight stenosis. Coronary angiography through the right radial access was performed, showing a dominant tortuous and calcified left circumflex (LCx) with a tight proximal stenosis, followed by aneurysmal dilation and thrombus. The patient received an intravenous bolus of aspirin (250 mg), loading dose of ticagrelor (180 mg), and primary PCI was indicated. A 71-year-old diabetic man was admitted for inferior ST- elevation myocardial infarction, 2 hours after chest pain onset. Subsequently, the procedure can be continued as usual, without need for disconnection and reattachment. Once the guide catheter and guide wire are placed, the GuideLiner catheter can be advanced over the guide wire through the hemostatic valve as an extension to the guide catheter. It is available in 4 sizes: 5.5, 6, 7, and 8 Fr. The more recent GuideLiner V3 catheter has a 25-cm cylinder at the distal tip and a half-pipe design facilitating smooth device entry and delivery ( Figure 1). The GuideLiner V2 catheter provides additional extension of 5 cm and presents all polymer collar for increased flexibility. It consists of a coaxial exchange system joined to a 125-mm compact metal hypotube, and a flexible extension of 20 cm with a radiopaque marker located 2.7 mm from the tip and an inner diameter 1-Fr size smaller than the guiding catheter. The GuideLiner catheter (Vascular Solutions Inc., Minneapolis, MN, USA) is a coaxial “mother and child” catheter mounted on a monorail system extending the guide catheter. We report two didactic cases showing the usefulness of the GuideLiner device in everyday catheterization laboratory practice. 7-9 As a “mother and child” system, the GuideLiner catheter (Vascular Solutions Inc., Minneapolis, MN, USA) provides an extension to the guide catheter with a better coaxial alignment and stability. 6 The use of stiffer guide wire, anchoring balloon technique, and deeper intubation of the guide catheter may represent, in some cases, reliable options able to improve back-up support. Regardless of the clinical setting, a good back-up represents one of the most important conditions to ensure guide wire and balloon advancement and stent delivery, thereby leading to PCI success. to the development of equipment and techniques, 1,2 particularly in the wake of chronic total occlusion revascularization, 3-5 percutaneous coronary intervention (PCI) has reduced the surgical indications of myocardial revascularization.
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