We describe the initial experience with the use of the GuideLiner ® in a single center.įigure 1. It is compatible with standard guiding catheters (except those with a conical tip) and its lumen is 1 Fr smaller than that of the catheter utilized. In addition, it provides an extension to the guiding catheter that, on occasion, makes it possible to gain access to the ostia of hard-to-reach coronary arteries or coronary bypass grafts. The flexible design of the catheter and the absence of a distal primary curve permit deep and theoretically atraumatic intubation of the coronary tree, increasing guiding catheter support, which enables selective injections and reduces the amount of contrast medium employed. It has a distal end of 20cm, consisting of a flexible extension with a radiopaque marker situated 2.7mm from the tip and a coaxial exchange system 20cm from the tip, joined to a 125-mm compact metal hypotube by means of a ring ( Figure 1). The GuideLiner ® catheter (Vascular Solutions Inc., Minneapolis, Minnesota, United States) is a coaxial “mother and child” catheter, mounted on a monorail system, that extends the angioplasty guiding catheter and enables deep intubation of the coronary artery to achieve extra support and improve coaxial alignment. Deep intubation of the coronary artery is another of the strategies, but is limited by the possible occurrence of the dissection of proximal plaques or total occlusion of the vessel during maneuvers of this type. In complex angioplasty procedures of this type, different strategies have been emerging to resolve the problem of inadequate guiding catheter support, including the use of high-support guide wires and techniques involving buddy wires, buddy balloons, or anchoring balloons (inflation of an anchoring balloon in side branches).
Stent placement frequently poses considerable difficulty in coronary interventions, especially in tortuous or calcified arteries and chronic occlusions this is evidenced by the fact that failed stent deployment still occurs in 2.7% to 3.3% of the interventions undertaken.
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