A novel method for prevention of intravascular ultrasound catheter entrapment using soft guide extension catheter
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IMAGES IN CARDIOVASCULAR INTERVENTION
A novel method for prevention of intravascular ultrasound catheter entrapment using soft guide extension catheter Takunori Tsukui1 · Kenichi Sakakura1 · Shin‑ichi Momomura1 · Hideo Fujita1 Received: 1 November 2019 / Accepted: 20 January 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Intravascular ultrasound (IVUS) plays an important role in optimal procedures in complex percutaneous coronary interventions (PCI). IVUS catheter entrapment is a rare, but serious complication following stent implantation. Although several percutaneous bailout techniques have been reported [1], prevention of IVUS catheter entrapment is more important than bailout techniques, because there is no guarantee whether any bailout techniques work in various clinical settings. In this case report, we show the utility of soft guide extension catheter to prevent IVUS catheter entrapment. An 84-year-old male with chronic renal failure was admitted to our hospital because of non-ST segment elevation myocardial infarction. He had a history of drug-eluting stent implantation (Nobori 3.5 × 14 mm, Terumo, Tokyo, Japan) to the proximal segment of right coronary artery (RCA). Coronary angiogram showed a severely calcified and tortuous lesion just distal at the previous DES (Fig. 1a). First, we tried to advance an IVUS catheter (OptiCross: Boston Scientific, Natick, USA) beyond the lesion, but could not. Then, the IVUS catheter was suddenly entrapped within the previous DES. We pushed the IVUS catheter using a small-sized balloon and could bailout the situation (Fig. 1b). We performed halfway rotational atherectomy to the lesion using a 1.5-mm burr followed by non-compliant balloon (2.75 × 12 mm) dilatation [2]. After halfway rotational atherectomy, we retried to cross the IVUS catheter, because we aimed to minimize the contrast volume. We used a soft
guide extension catheter (Guideplus: Nipro, Osaka, Japan) to prevent IVUS catheter entrapment. The IVUS catheter was smoothly moved via the Guideplus. We implanted another DES (Synergy 3.0 × 24 mm, Boston Scientific, Natick, USA) (Fig. 1c), and performed IVUS with the support of soft guide extension catheter (Fig. 1d, e). The Guideplus is a unique guide extension catheter characterized by its softness and hydrophilic coating, which showed better performance over the conventional guide extension catheter [3]. For the purpose of prevention of IVUS catheter entrapment, the guide extension catheter should work as the protective sheath and advance beyond the distal edge of implanted stents without the anchor balloon technique. Although this technique is available for other guide extension catheters, the Guideplus would have an advantage over the conventional guide extension catheter, because the Guideplus rarely requires the anchor balloon technique. We should mention the limitation of this technique. Since the inner lumen of Guideplus is small, only small profile IVUS catheters such as OptiCross can pass through the Guideplus. Hiraya
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