Usefulness of conquest guidewire for retrieval of an entrapped rotablator burr.

We experienced an entrapped rotablator burr that could not be retrieved even by deep seating of the guiding catheter. We successfully retrieved the burr by balloon inflation after the tapered tip of a Conquest wire managed to penetrate the quite hard plaque and pass through the outer lumen of the burr.     

Successful retrieval of a firmly stuck rotablator burr by using a modified STAR technique

Rotablator burr entrapment occurring during rotational atherectomy is a rare but serious complication that can lead to coronary occlusion and require emergency cardiac surgery. Although several bailout techniques for stuck burrs have been proposed, no definitive methods for removal have been established. We report here a difficult case of a stuck rotablator burr, in which various techniques failed to retrieve the burr. It was ultimately removed using the subintimal tracking and reentry (STAR) technique with a 3‐g tapered tip hydrophilic wire. This modified STAR technique, which was originally developed for percutaneous coronary intervention for chronic total occlusion, may be useful as a bailout technique in patients with a firmly stuck rotablator burr that cannot be removed by using standard procedures. © 2015 Wiley Periodicals, Inc.     

Retrieval of directional coronary atherectomy guiding catheter with angioplasty balloon catheter

Directional coronary atherectomy (DCA) has been shown to be a safe and effective treatment for occlusive coronary artery disease. We report a case of an atherectomy guiding catheter severing in two with successful retrieval of the dislodged segment by an integrated angioplasty balloon catheter system. © 1995 Wiley-Liss, Inc.     

New techniques for guiding catheter management during directional coronary atherectomy

Directional coronary atherectomy (DCA) is an important advance in the mechanical revascularization of stenotic coronary arteries. The bulky nature of the DCA device has necessitated the use of guiding catheter designs that are more cumbersome to use than balloon angioplasty guiding catheters. Because engagement of coronary artery ostia with the currently available DCA guiding catheters is often difficult and because DCA guiding catheters significantly “relax” and reshape during the atherectomy procedure, angiography using these guiding catheters before and after atherectomy can be suboptimal. A new technique for angiography during atherectomy using long Judkin's diagnostic catheters inserted through the existing DCA guiding catheters is described. This technique can be used for optimal visualization of the coronary arteries with minimal use of contrast before and after sessions of atherectomy and also can be used to help engage the DCA guiding catheters. Some improvements in the design of guiding catheters for DCA are suggested. © 1993 Wiley-Liss, Inc.     

GuideLiner,a child‐in‐a‐mother catheter for successful retrieval of an entrapped rotablator burr

Entrapment of the rotablator burr within heavily calcified lesions is a recognized complication, which usually necessitates sternotomy and open surgical intervention to retrieve the trapped burr. In some cases, the trapped burr can be retrieved using simple traction, but this is potentially hazardous with possible trauma and perforation of the vessel. Passing a wire alongside the trapped burr with ballooning to free the burr can be attempted. We describe a novel technique to remove a trapped rotablator burr from a heavily calcified lesion using counter‐traction with a GuideLiner, child‐in‐a‐mother catheter, which successfully removed the entrapped burr without the need for surgery when simple traction alone had been ineffective. © 2011 Wiley Periodicals, Inc.     

Successful rescue of stuck rotablator burr entrapment using a Kiwami straight catheter

Rotational atherectomy is an indispensable modality for percutaneous coronary intervention of severely calcified lesions. An entrapped rotablator burr is a rare but life‐threatening complication because retrieval is difficult. Although emergent surgical removal is a reliable option for this complication, it is invasive. There are various methods to retrieve an entrapped burr by bailout endovascular approaches. We present two cases of successful rescue of stuck rotablator burr entrapment using a Kiwami straight catheter (4 Fr, Heartrail II, Terumo, Tokyo, Japan). © 2015 Wiley Periodicals, Inc.     

Percutaneous coronary interventions using a new 5 French guiding catheter: results of a prospective study.

The aim of this prospective study was to analyze the technical feasibility, the success rate, and the special complications of percutaneous coronary interventions (PCIs) using a newly released 5 Fr guiding catheter with an inner diameter of 0.058". The study was performed in 150 consecutive patients subjected to coronary angioplasty. In 89% of the patients, the intervention was started with a 5 Fr catheter (JR4 or JL4); in 16 patients a 6 or 7 Fr catheter was used because of unstable clinical conditions according to the decision of the interventional cardiologist. In 12 out of 134 patients, the guiding catheter had to be changed during the intervention from 5 Fr to a 6 or 7 Fr catheter due to poor backup support. In 112 out of 118 patients, the intervention was successfully performed using a 5 Fr catheter (95%); in 12 out of 16 patients, after changing the guiding catheter, the overall success rate was 93%. In patients with type A and B lesions who were initially treated using a 5 Fr catheter, the procedural success rate was 100% (81 out of 81), whereas in patients with type C lesions the procedural success rate was 83% (43 out of 53; P = 0.000053, Fisher's exact test). Furthermore, in patients with a diameter stenosis < 90%, the procedural success rate was 100% (57 out of 57), whereas in patients with a diameter stenosis of 90%-100%, the procedural success rate was 87% (67 out of 77; P = 0.0050). Stent implantation was performed successfully in 24 patients (18%) using the 5 Fr guiding catheter. This study confirms that PCI was technically feasible using a 5 Fr guiding catheter in the majority of consecutive patients with a success rate of 95%. There were significant differences in the success rate depending on the lesion type and the diameter stenosis. Complications were very rare and were not related to the guiding catheter. Limitations of the 5 Fr guiding catheters arose mainly from a poor backup support in long lesions and severe stenosis. Cathet Cardiovasc Intervent 2001;53:308-312. Copyright Wiley-Liss, Inc.     

血管扩张药物干预下经桡动脉入径应用7 Fr指引导管治疗冠状动脉分叉病变的可行性与安全性

目的评价血管扩张药物干预下经桡动脉入径应用7 Fr指引导管治疗冠状动脉分叉病变的可行性与安全性。方法入选2012年1月至2014年7月经冠状动脉造影示分叉病变且适合行经皮冠状动脉介入治疗(PCI)的患者,随机分成经桡动脉6 Fr指引导管组(6 Fr组)和7 Fr指引导管组(7 Fr组)。对比观察两组患者动脉鞘管置入成功率、手术操作成功率、完成PCI操作时间、X线透视时间和对比剂用量。随访住院期间、术后30 d内的入径血管相关并发症及主要不良心血管事件。结果共纳入229例冠状动脉分叉病变患者,其中6 Fr组113例,7 Fr组116例。两组患者年龄、性别、体重指数、危险因素、临床特征、住院时间等方面比较,差异均无统计学意义。6 Fr组行常规鞘管置入;7 Fr组先行6 Fr鞘管置入,在充分局部麻醉并给予血管扩张药物的基础上更换为7 Fr动脉鞘管。6 Fr组有4例患者换用7 Fr指引导管进行手术操作;7 Fr组均成功完成PCI术,无患者转至6 Fr组。与6 Fr组相比,7 Fr组完成PCI操作时间更短[(52±9.2)min比(60±10.7)min,P0.0001],球囊应用数量更少[(2.9±0.6)枚比(3.2±0.4)枚,P=0.002],X线透视时间更短[(24±8.2)min比(28±9.4)min,P=0.02]。两组对比剂用量比较,差异无统计学意义[(152±25.8)ml比(158±23.5)ml,P=0.20]。住院期间6 Fr组和7 Fr组前臂血肿[4/113例(3.5%)比6/116例(5.2%),P=0.76]及桡动脉闭塞[4/113例(3.5%)比9/116例(7.8%),P=0.26]的发生率分别比较,差异均无统计学意义。术后30 d随访,两组桡动脉闭塞的发生率相似[2/99例(2.0%)比4/103例(3.9%),P=0.70],且均未见掌弓循环障碍的临床表现。结论在血管扩张药物的作用下,桡动脉血管内径增大,可容性增强,利于7 Fr指引导管分叉病变治疗操作,安全可靠,且并未增加血管并发症发生率。     

Coronary angioplasty using an autoperfusion balloon catheter through a 6 french guiding catheter

Use of 6 French guiding catheters for elective percutaneous transluminal coronary angioplasty has been limited by lack of a compatible autoperfusion balloon catheter for management of complications such as acute vessel closure and large subintimall dissections. We describe the successful use of a lower profile autoperfusion balloon catheter through large internal lumen 6F guiding catheters for elective coronary angioplasty. These cases demonstrate the feasibility of the use of autoperfusion balloon catheters with 6F guiding catheters in elective, and presumably also in emergent, settings. © 1993 Wiley-Liss, Inc.     

Percutaneous pulmonary angioscopy using a guiding balloon catheter

The applicability of angioscopy for observation of the pulmonary arterial lumen was examined in 7 anesthetized dogs and in 10 patients with various heart diseases during cardiac catheterization. A novel guiding balloon catheter (#11F shaft diameter and 1.5 cm in balloon diameter) was introduced through the right femoral vein into the pulmonary artery by Seldinger's method. Then, a fiberscope (1.3 or 1.8 mm in diameter) was introduced through the guiding catheter into the desired portion of the artery. The balloon was inflated, saline was infused, and the pulmonary arterial lumen was photographed on 16-mm color cinefilms. In all dogs and patients examined, an increase in diameter of the pulmonary artery during systole and the backflow of blood from the pulmonary vein were clearly demonstrated. Also, pulmonary thrombi or emboli experimentally induced in dogs could be observed. No complications were observed in the patients. The results indicate the experimental and clinical applicability of angioscopy using a guiding balloon catheter for observation of the pulmonary arterial lumen.     

Long-tip guiding catheter: Successful and safe for left coronary artery angioplasty

A long-tip guiding catheter was designed for angioplasty of the left coronary artery. Principal factors of guiding catheter function were identified, and the catheter's shape was designed to utilize them efficiently. Emphasis was placed on an overbent secondary curve (150–180°) for more precise catheter control. The distal tip of the catheter is 2 cm long in the 4.0 size and the primary bend is shallow, ～20%. A 1.5 cm long segment between the secondary and tertiary curves enhances stability and support. Catheter performance was studied during procedures on 90 patients; 89 patients underwent coronary artery angioplasty and one patient underwent diagnostic angiography. The success rate for angioplasty was 95% with no major complications. Mild pressure damping occurred in 18 patients, and mild catheter displacement from the left main coronary artery occurred in 24 patients. Catheter support was judged as excellent to very good in 82 patients. Judkins or Amplatz catheters were not required during this study. The observed disadvantages of the long-tip catheter were the risk of catheter buckling up during advancement into the left main coronary artery and, perhaps, a higher risk of pressure damping. Superselective engagement of the catheter in the left anterior descending or circumflex arteries may be a problem when the left main coronary artery is very short. This study showed the long-tip catheter to be safe and highly successful for angioplasty of the left coronary artery.     

Successful removal of an entrapped rotablation burr by extracting drive shaft sheath followed by balloon dilatation

Burr entrapment is a rare but serious complication during rotational atherectomy (RA). Although emergent surgical removal is a reliable option for this complication, surgical removal is invasive and takes several hours. Balloon inflation just proximal to the burr was the previously‐reported nonsurgical option for burr removal. However, this method needed large guide catheter lumen (≥8 Fr). We present a case of 67‐year‐old male on chronic hemodialysis. During RA for severe stenosis of the right coronary artery, the RA burr was entrapped. We cut off the drive shaft, the drive shaft sheath, and the RA wire together near the advancer, and then we removed the drive shaft sheath. After removing the drive shaft sheath, the 2.5 mm balloon easily entered the 7‐Fr guide catheter. We inflated that balloon to a pressure of 18 atm. The burr was easily removed immediately after balloon deflation. Removal of the drive shaft sheath following balloon dilatation is a new, nonsurgical bailout method for a burr that becomes entrapped during RA. Since removal of the drive shaft sheath following balloon dilatation can be applied to 7 Fr as well as 6 Fr guide systems, this method may be of considerable benefit when operators use 7 Fr or 6 Fr systems. © 2011 Wiley‐Liss, Inc.     

Amplatzing a 6 Fr Judkins right guiding catheter for increased success in complex right coronary artery anatomy.

Stent supported angioplasty is being performed in an increasing number of patients and, with advances in device technology, more morphologically complex lesions are being treated. In such a setting, it is extremely important to deliver the device to the target lesion. We describe a new technique that allows successful stent delivery in complex right coronary anatomy using the Judkins right guiding catheter. Cathet Cardiovasc Intervent 2001;53:405-409.     

New method to increase a backup support of a 6 French guiding coronary catheter.

A 6 Fr guiding catheter is commonly used in the percutaneous coronary intervention (PCI). However, one of the limitations of the 6 Fr guiding catheter is its weak backup support compared to a 7 or an 8 Fr guiding catheter. In this article, we present a new system for PCI called the five-in-six system. Between March 2003 and September 2003, this system was tried on eight chronic total occlusion cases. The advantage of the five-in-six system is that it increases backup support of a 6 Fr guiding catheter.     

Directional coronary atherectomy in a distal right coronary lesion using a shorter standard guide catheter

An ulcerated and eccentric distal right coronary artery plaque was found in a 56-year-old male with post-infarction angina. The 100 cm length of present DVI (Devices for Vascular Intervention, Inc., Redwood City, CA) atherectomy guiding catheters limits the ability to reach many complex distal stenoses with the 125 cm Simpson Atherocath. After shortening the proximal portion of a standard DVI Judkins right guiding catheter without changing the distal contour, successful directional coronary atherectomy was performed. © 1993 Wiley-Liss, Inc.     

SAL指引导管使用56例初步经验

目的:初步总结短头AL（short amplatz left，SAL）指引导管（guiding catheter，GC）的使用经验，评价SAL GC的使用特点及安全性。方法: 回顾分析总结我科56例使用SAL导管行右冠状动脉（RCA）介入治疗患者的影像特点，操作过程及最终结果。56例患者中慢性完全性闭塞（CTO）病变29例；病变迂曲8例；病变明显钙化10例；迂曲并发钙化5例；病变位于RCA远端且近中段迂曲14例。结果: 56例患者中SAL GC成功到位53例（95%），3例不能到位。53例使用SAL GC完成PCI手术，PCI成功46例，成功率87%，失败7例（13%），均为CTO病变；CTO病变的成功率为76%（22/29），失败原因为导丝不能通过5例，术中过敏反应1例，心室颤动1例，均顺利中止手术。56例中无1例发生RCA开口或近端夹层，也无右窦内夹层发生。结论: SAL GC操作简单，容易到位，适合大部分RCA复杂病变，具有良好的安全性。     

Coronary angioplasty of bifurcational lesions with the protecting branch technique using 6 French guiding catheter

The use of 6 French guiding catheters is still usually limited to elective percutaneous transluminal coronary angioplasty. We describe our preliminary experience with this guiding size to perform a double guide wire procedure for angioplasty of coronary bifurcation lesions, to protect (n = 5) and/or to sequentialy dilate (n = 9) a major side branch. Technical success was 12/14 (86%), angiographic success 13/14 (93%), and in-hospital outcome was event free in all patients. Thus, 6 French guiding size is both safe and effective for the majority of coronary bifurcation angioplasty.     

Evaluation of a new 9F guiding catheter for directional coronary atherectomy

Large lumen guiding catheters (9.5 to 11 French) are currently required to perform directional atherectomy. These rigid guiding catheters require modifications of usual techniques for manipulation and can induce ostial trauma and peripheral vascular complications. A new type of 9 French guiding catheter (Vista Brite tip, Cordis, Miami, FL) with an inner diameter of 0.098 inch and capable of accommodating atherectomy catheters (SCA-EX) was evaluated. In this preliminary study, 31 consecutive patients were included. Primary success was obtained in 27 (87%); no ostial trauma and only two minor groin hematomas were observed. After exchange with a conventional 10F guiding catheter, because of poor back-up, two of the four failures were successfully treated by DCA. In conclusion, these new 9F guiding catheters provide a useful alternative to currently available guiding catheters for DCA. Nevertheless, new shapes with better back-up are necessary to improve the primary success rate. © 1996 Wiley-Liss, Inc.     

ST段抬高型心肌梗死患者行经皮冠状动脉介入治疗时应用单根指引导管的有效性与安全性

目的评估急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经桡动脉途径行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中依据术前检查结果,直接使用单根指引导管的有效性与安全性。方法连续入选2017年1月至2019年1月于汕头市第二人民医院住院,诊断为STEMI且具有急诊冠状动脉造影及PCI治疗指征的患者120例。用随机数字表法以1∶1随机分为试验组与对照组。对比两组门-球囊(door-to-balloon,D2B)时间、穿刺至球囊时间、住院时间及半年主要不良心血管事件(major adverse cardiac event,MACE)发生率等。结果试验组中的D2B时间[(65±15)min vs.(73±19)min,P=0.01]和穿刺至球囊时间[(18±10)min vs.(28±13)min,P<0.001]比对照组更短,差异有统计学意义。在试验组中,使用指引导管的数量显著低于对照组,差异有统计学意义(P<0.05)。30 d随访过程中,两组均有2例MACE发生,两组MACE发生率比较,差异无统计学意义(P>0.05)。结论依据术前检查的结果,直接使用单个指引导管在STEMI患者中行急诊PCI治疗能有效缩减D2B时间。