![]() Unfortunately, none of the tested devices provide any space for the 1.75 mm burr, mainly due to the large diameter of the transparent sleeve. It seems that all 7 Fr devices cooperate with the 1.50 mm burr without any problems. The above-mentioned extensions that provide friction could be recommended only in bail-out situations or vessels that are not able to accept 7 Fr devices. The only extension which works with the 1.25 mm burr is the Guidezilla 6 Fr. One should note that aorta or large arterial vessel kinking may lead to the burr getting stuck. Of course, in in vivo circumstances, it could lead to problems with burr advancement. Two of the 6 Fr extensions (Guideliner and Guidon) are able to host the 1.25 mm burr but with perceptible friction. Theoretically, all extensions should be well fitted with a 1.25 mm burr, but in our tests two of them failed. ![]() Using commercially available extensions and two sizes of rotablation burr (1.25 and 1.50 mm) we found that there is a mismatch between producer declaration regarding inner size of the device and possibility of burr advancement deep into the extension. In our daily practice, we have faced this situation quite often, but several attempts during coronary angioplasty failed because of burr friction or getting stuck as well as mismatching of these two components. To our best knowledge, this is the first report comparing different guide catheter extensions with respect to feasibility of rotational atherectomy burr deliverability. The idea to use guiding catheter expansion to allow rotational atherectomy to be performed in a distal coronary lesion or increase guiding catheter support is not new. In this scenario, the operator should safely advance the burr as far as possible and start the rotablation at the closest point to the lesion. One knows that non-significant calcifications along the artery may affect the risk of the burr getting stuck if delivered during “dyna mode”. Of course, for many distal locations, it is too short to reach the lesion if the operator parks the burr just outside the guiding catheter. So far, the commercially available system for high speed rotational atherectomy has used a special advancer that allows one to perform a movement of about 7 cm. Limited technical features of rotational atherectomy were a significant hindrance to using it for this location. Use of the Guideliner facilitated successful completion of PCI despite the use of a wide variety of guiding catheters in this series.Īngiography Coronary intervention Transradial.Calcified distal coronary lesion treated by coronary angioplasty remains a huge challenge for every interventional cardiologist. Proximal vessel angulation is significantly associated with the need for GuideLiner use during transradial intervention. TRIs requiring GuideLiner catheter support had significantly increased lesion complexity and vessel tortuosity. None of the Guideliner TRI cases required conversion to femoral access. A 45° proximal vessel angle predicted the need for GuideLiner use with a sensitivity of 73% and specificity of 74% (c-statistic 0.79). On multivariable analysis, proximal vessel angle independently predicted the need for GuideLiner support (AOR 1.4 per 10°, p<0.001). Lesion angle in the Guideliner group was also significantly greater (48°☓2° vs. The proximal vessel angle was significantly greater in the cases requiring GuideLiner support (74°☓5° vs. ![]() Subjects who required use of the GuideLiner support catheter at the time of TRI were significantly older (69☑2years vs. The indications for TRI were similar between both groups. Multivariable analysis and receiver operator curves (ROC) were used to analyze predictors of GuideLiner use. Procedural and angiographic characteristics of all cases were analyzed. 22 cases (15%) required use of the GuideLiner support catheter. This was a retrospective study reviewing 146 TRI cases performed at a single institution between August 2010 and June 2012. ![]() We hypothesized that TRI cases requiring GuideLiner support would have a greater proximal vessel angle and increased lesion angle tortuosity. The GuideLiner catheter (Vascular Solutions, Minneapolis,MN) is a guide catheter extension developed to provide increased guide catheter support. Transradial coronary intervention (TRI) is increasingly common, but anatomic variations and lack of guide catheter support may increase the complexity of TRI.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |