Off-label use of 7Fr GuideLiner in the bifurcation coronary intervention protecting 2 side branches

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CASE REPORT

Off-label use of 7Fr GuideLiner in the bifurcation coronary intervention protecting 2 side branches Takayuki Warisawa1 • Toru Naganuma1 • Sunao Nakamura1

Received: 19 July 2016 / Accepted: 27 September 2016  Japanese Association of Cardiovascular Intervention and Therapeutics 2016

Abstract We report a case of percutaneous coronary intervention in a bifurcation lesion involving left circumflex (LCx) artery and 2 major posterolateral (PL) arteries. The target LCx had diffuse long and severely calcified lesion with the acute takeoff angle from the left main. Despite adequate lesion preparation with rotational atherectomy and balloon angioplasty, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. Conventional use of guiding extension catheter (GEC) would have required removal of a wire from at least one PL because of the device interference in the GEC. However, successful stenting was achieved without removal of wires from both PL with 7Fr GuideLiner. We have also demonstrated this mechanism on ex vivo bench testing. Keywords GuideLiner  Bifurcation  Side branch protection

Introduction The guiding extension catheter (GEC) system is an effective option in the complex percutaneous coronary intervention (PCI), which provides adequate back-up guiding catheter support by deep coronary intubation [1–3]. The GuideLiner (GL) (Vascular Solutions Inc., Minneapolis, MN, USA) is a rapid exchange GEC, which is easy to use as it does not require disconnection of the haemostatic valve at the proximal end of the guiding catheter [4]. Its usefulness and safety & Sunao Nakamura [email protected] 1

Department of Cardiovascular Medicine, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan

in the complex PCI have been reported in several studies and case reports [5–9]. In this report, we demonstrate the novel technique using 7Fr-GL in the bifurcation lesion complemented by ex vivo bench testing.

Case description A 67-year-old Chinese gentleman was referred to our institution from China to undergo PCI for three vessel diseases, because he rejected coronary artery bypass surgery. After successful revascularization for right coronary artery and left anterior descending artery with Ultimaster (Terumo Corporation, Tokyo, Japan), PCI for left circumflex (LCx) artery was planned. The LCx had diffuse long and severely calcified lesion with the acute takeoff angle from the left main and with bifurcation lesion involving 2 major posterolateral (PL) arteries (Fig. 1). Transfemoral access was gained with a 7Fr arterial sheath and a 7Fr extra back-up guiding catheter (EBU3.5, Launcher, Medtronic, Minneapolis, MI, USA) was used after standard heparinisation. After lesion preparation with rotational atherectomy (1.25 and 1.5 mm Rotablator, Boston Scientific, Natick, MA, USA) (Fig. 2a), the delayed flow to the PL2 was observed, which required the wire protection of PL2 using micro-catheter (TERESA, Boston Scientific) (Fig. 2b). For fear of compromising PL1 flow after balloon angio

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