Deep intubation of a GC extension just proximal to the stent allowed delivery of an intravascular lithotripsy (IVL) balloon (D).Ĭare needs to be taken to avoid pushing against resistance. An unexpanded stent in the second obtuse marginal branch (C). The low anterior origin right coronary artery (RCA) resulted in poor guide support, but deep GC extension intubation into the RCA provided enough support to cross the occluded posterior descending artery (A, B). The TrapLiner catheter (Teleflex) has a shorter, 13-cm rapid exchange catheter portion and a balloon on the pushrod that is used to trap the wire to facilitate removal and delivery of over-the-wire equipment.įigure 2. Commonly used systems-available in 5, 5.5, 6, 7, and 8 F-include the GuideLiner catheter (Teleflex Figure 1), Guidezilla (Boston Scientific Corporation), Telescope (Medtronic), and Guidion (IMDS). The pushrod transitions into the catheter extension as a half-pipe to orientate equipment appropriately. The proximal end of the extension is attached to a thin stainless-steel pushrod, which is used to push and pull the system independent of the GC and exits at the hemostatic valve. It is 1-F less thick than the GC and is designed to minimize trauma to the coronary artery. The guide extension portion is an average of 25-cm long it is passed over the guidewire in a rapid exchange fashion and extends beyond the distal end of the GC. MATERIALS NEEDEDĪ GC extension is a monorail system. 3-5Ĭlick the image to watch a video demonstrating GC extension. This article will focus on the numerous additional applications of GC extensions that have now evolved, including the bypass of calcification and tortuosity to deliver stents, contrast limitation via selective contrast injection, multiple applications in CTOs, engagement of aberrant-origin coronaries or bypass grafts, thrombus aspiration in ST-segment elevation myocardial infarction (STEMI), and PCI through transcatheter aortic replacement valves. 2 Among the options for increasing GC support is the use of a GC extension. When using these guides transradially, they generally offer less support, and alternative methods of increasing GC support may be needed. 1 Current GCs were designed for use via the femoral approach. Transradial PCI has now become the default PCI approach globally.
Dealing with such lesions requires a high degree of guide catheter (GC) support to cross lesions, advance microcatheters and balloons, and deliver stents. Current patients are older and have more comorbidities, prior coronary bypass surgery, lesion calcification, tortuosity, and chronic total occlusions (CTOs).
Contemporary percutaneous coronary intervention (PCI) involves the treatment of ever more complex lesion subsets.
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