|Year : 2014 | Volume
| Issue : 1 | Page : 12-14
Use of guideliner cathater in saphenous vein graft: A case report
Ahmet Tastan, Erdem Ozel, Ali Ozturk, Samet Uyar, Omer Senarslan, Talat Tavli
Department of Cardiology, Sifa University, Izmir, Turkey
|Date of Web Publication||17-Feb-2014|
Fevzipaşa Bulvarı No:172/2 35240 Basmane, Izmir
Source of Support: None, Conflict of Interest: None
Guideliner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the complex coronary lesions. We describe the use of this device in a percutaneous intervention of a native diagonal lesion through tortious and calcific saphenous vein graft.
Keywords: Guideliner catheter, percutaneous intervention, saphenous vein graft
|How to cite this article:|
Tastan A, Ozel E, Ozturk A, Uyar S, Senarslan O, Tavli T. Use of guideliner cathater in saphenous vein graft: A case report. Sifa Med J 2014;1:12-4
|How to cite this URL:|
Tastan A, Ozel E, Ozturk A, Uyar S, Senarslan O, Tavli T. Use of guideliner cathater in saphenous vein graft: A case report. Sifa Med J [serial online] 2014 [cited 2019 Jan 21];1:12-4. Available from: http://www.imjsu.org/text.asp?2014/1/1/12/127221
| Introduction|| |
Performing the angioplasty procedure with the support of guiding catheter in saphenous vein graft (SVG) lesions itself and distal native coronary lesions via grafts affects the duration and success of the procedure and usage of opaque material.
Several different guiding catheters have been developed for selective positioning of left and right coronary arteries. Catheters could be chosen according to coronary ostium anatomy. Options of guiding catheter for saphenous ostium is limited. Positioning and support could not be always achieved with Judkins right (JR) guiding catheter which is generally used. Especcially when crossing through serious tortious and calcific lesions after grafts with baloon catheters and stents, guiding catheter support became inadequate and the procedure could fail. In recent years, several different techniques have been developed to overcome this problem. Guideliner catheter is a new mother and child catheter which extends the guiding catheter and provides extra support for crossing the complex lesions.
| Case Report|| |
Our patient was 69-years-old and had a coronary artery by-pass surgery in 1998. She was admitted to our center with the diagnosis of acute coronary syndrome and elevated troponin levels. She did not have a ST elevation during observation and taken to coronary angiography because of troponin rise. On coronary angiography; left anterior descending artery (LAD) was occluded, left internal mammarian artery (LIMA) -LAD graft was patent, right coronary artery (RCA) was occluded, first optus margine artery (OM1) was occluded, optus margine saphenous vein graft (OM1-SVG) was patent with a proximal lesion of 40% and first diagonal saphenous vein graft (D1-SVG) was patent. There was a serious, calcific and tortious lesion of 99% on the mid portion of native D1 after distal saphenous anastomosis [Figure 1]. Coronary angioplasty was planned to D1 lesion which was thought to be responsible for ischemia.
Cannulation was performed to saphenous graft with 7 French right Judkins guiding catheter (Boston Scientific Medical, USA). 0.014 guidewire was advanced to lesion in mid D1 via saphenous graft. Guidewire could not be crossed to distal part of the tortious, calcific and high grade lesions. Guiding catheter support failed. Saphenous graft was recannulated but adequate support could not be achieved. After failed attempts, 6F guideliner catheter was advanced with the length of 30 mm through 7F guiding catheter to the mid portion of saphenous graft [Figure 2]. 0.014 floppy guidewire was advanced to the distal part of the lesion with the support of guideliner catheter. 2.5 × 15 mm Maverick coronary angioplasty baloon (Boston Scientific Medical, USA) was crossed from the lesion and dilatations were performed. Coronary stent implantation was planned because of recoil. 2.5 × 12 mm Liberte drug eluting coronary stent (Boston Scientific Medical, USA) could not be crossed from lesion. The guideliner catheter was far advanced to the lesion with the length of 60 mm.[Figure 3] [Video 1]. Full engagement with guideliner catheter was achieved. 2.5 × 12 mm Liberte drug eluting coronary stent was succesfully crossed after selective positioning of diagonal artery. Optimal opening of lesion was achieved after stent dilatation. [Figure 4]. Lesion was cured with no complication.
| Discussion|| |
Over the last decade, as interventional cardiologists became more experienced with complex coronary lesions, several different techniques and advancements have been achieved. Especially tortious, calcific and high grade lesions are still a big problem to solve. Equipment delivery in these kinds of lesions could be challenging. Using a more supportive guiding catheter, deep intubations to facilitate stent delivery, using more supportive guidewires, buddy wire techniques and anchor techniques are some examples of methods to solve the problem. 
Guideliner catheter is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the lesion.  There were three size of guideliner catheter; 6F, 7 F and 8F. In our case we used 6 F size through the 7 F guiding catheter.
There are few reports about the SVG interventions with guideliner catheter. , Even without use of guideliner, native coronary stenting via SVG, advancing to the lesion and guiding support could be problematic. Guideliner system could facilitate the procedure but it has also some disadvantages and important issues which needs to be careful about.
In SVG lesions, the intubation length of the guideliner is an important point. The catheter is normaly 145 cm long and has a 20 cm single lumen extension which enters the coronary vessel. Longer intubation with the catheter leads to higher risk of coronary dissection. In general, advancing the extension catheter more than 100 mm is not advised (According to previous reports and reviews; intubation length of more than 100 mm is not recommended. , As we could not deliver the stent with 30 mm of support in the first attempt, we had to advance the catheter about 60 mm for full engagement of the diagonal artery. After that the stent delivery succeeded. There was no dissection in our case.
Another risk of deep intubation with guideliner is arteriel pressure waveform dampening. Luna et al., reported dampening in 12 of 21 patients and this situation was directly affect to 3 of 4 unsuccessful guideliner cases in their series.  We did not experience pressure dampening in our case, but attention should be paid especcially in deep coronary interventions.
Our case demonstrates the novel use of guideliner catheter in an individual procedure of native coronary stenting via saphenous graft. More usage of the catheter will broaden our knowledge and our experience in these kinds of cases.
| References|| |
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|2.||Mamas MA, Fath-Ordoubadi F, Fraser DG. Distal stent delivery with Guideliner catheter; First in man experience. Catheter Cardiovasc Interv 2010;76:102-11. |
|3.||Luna M, Papayannis A, Holper ME, Banerjee S, Brilakis ES. Transfemoral use of the guideliner catheter in complex coronary and bypass graft interventions. Catheter Cardiovasc Interv 2012;80:437-46. |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]