Guideliner vascular solutions2/20/2023 AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.ĭeep intubation of coronary guides may improve the backup support required to deliver interventional materials through 6 French catheters. The most frequently encountered AOCCA is LCx branching-off from RCA. In the remaining patients PCI was successfully performed. In 1 ST-elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS-patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non-STEMI). The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, LCA originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). : Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS.ĭifferent types of AOCCA in ACS were identified in 20 patients. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently. To describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. The events for both extension catheters mainly involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the extension catheter, extension catheter fracture, coronary artery dissection and perforation and, occasionally, the death of the patients. There were more reports on Guidezilla-related events during the search period. To assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters, the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried. Of the 408 cases with reported Guidezilla-related issues, 53 (13%) involved inability to pass or damaged PCI devices into the Guidezilla catheter, 117 (29%) involved inability to advance the Guidezilla catheter to the target lesion, 59 (14%) involved kinked Guidezilla catheter, mostly because of partial or complete catheter fracture upon further investigation, 164 (40%) involved a broken Guidezilla catheter, 10 (2.5%) involved coronary artery dissection, 2 (0.5%) involved coronary artery perforation, 1 (0.2%)involved aortic dissection, 1 (0.2%) involved thrombosis formation, and 1 (0.2%) involved no-reflow phenomenon.įindings from the MAUDE database highlight the complications and modes of events associated with the use of GuideLiner and Guidezilla extension catheters. Of the 65 cases with reported GuideLiner-related issues, 15 (23%) involved the inability to pass equipment through or damage to percutaneous coronary intervention (PCI) devices in the GuideLiner catheter, 38 (58%) involved GuideLiner catheter fracture, 9 (14%) involved coronary artery dissection, 2 (3%) involved coronary artery perforation, and 1 (1.5%) involved thrombus formation in the catheter. The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was queried for reported events. We aimed to assess the reported complications and event modes for the GuideLiner and Guidezilla extension catheters. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. The overall success rate was 88.9 ± 0.32% there were no relevant complications. All procedures were performed femorally the retrograde approach was used in 27.8 ± 0.46% of cases. The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes.Īlmost all lesions were classified as severely calcified (94.4 ± 0.24%). We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use. Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter.
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