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    30.3 Guide Extensions Rev 2020-10-24

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    All Bwin
    Guide catheter extensions can facilitate equipment delivery, coronary engagement, thrombectomy, retrieval of entrapped equipment, reverse CART, ADR, and KAM-snare procedures. They can help with difficult lesions by providing support and access. Their delivery requires techniques like inchworming and BAT. Complications include equipment deformation, dissection, thrombus formation, distal migration, and stent deformation.

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    © All Rights Reserved
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    30.3 Guide Extensions Rev 2020-10-24

    Uploaded by

    All Bwin
    63 views80 pages
    Guide catheter extensions can facilitate equipment delivery, coronary engagement, thrombectomy, retrieval of entrapped equipment, reverse CART, ADR, and KAM-snare procedures. They can help with difficult lesions by providing support and access. Their delivery requires techniques like inchworming and BAT. Complications include equipment deformation, dissection, thrombus formation, distal migration, and stent deformation.

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    Guide catheter extensions can facilitate equipment delivery, coronary engagement, thrombectomy, retrieval of entrapped equipment, reverse CART, ADR, and KAM-snare procedures. They can help with difficult lesions by providing support and access. Their delivery requires techniques like inchworming and BAT. Complications include equipment deformation, dissection, thrombus formation, distal migration, and stent deformation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views80 pages

    30.3 Guide Extensions Rev 2020-10-24

    Uploaded by

    All Bwin
    Guide catheter extensions can facilitate equipment delivery, coronary engagement, thrombectomy, retrieval of entrapped equipment, reverse CART, ADR, and KAM-snare procedures. They can help with difficult lesions by providing support and access. Their delivery requires techniques like inchworming and BAT. Complications include equipment deformation, dissection, thrombus formation, distal migration, and stent deformation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 80

    30.

    3
    Guide catheter extensions

    Emmanouil S. Brilakis, MD, PhD


    PCI: the steps
    1. Planning
    2. Monitoring
    3. Pharmacology
    4. Access
    5. Engagement
    6. Angiography
    7. Determine target lesion
    8. Wiring
    9. Lesion preparation
    10. Stenting
    11. Closure
    12. Physiology
    13. Imaging
    14. Hemodynamic support
    Equipment categories

    1. Sheaths 1. Guideliner V3
    2. Catheters 2. Trapliner
    3. Guide extensions 3. Guidezilla II
    4. Support catheters
    5. Y connectors
    4. Telescope
    6. Microcatheters 5. Guidion
    7. Guidewires 6. Heartrail 5 in 6 system
    8. Embolic protection devices
    9. Balloons
    10.Atherectomy
    11. Laser
    Guide catheter extensions

    Trapliner / Guideliner Guidezilla

    Telescope
    Guideliner
    Trapliner
    Balloon
    inflated to
    “trap” the
    guidewire
    Guidezilla
    Telescope
    Guidion
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    Approach to “balloon uncrossable” lesion
    “Balloon Uncrossable” lesion

    1. Small balloon
    2. Rupture balloon in vessel (grenadoplasty) 1st line

    Guide catheter
    3. Increase support 2nd line
    Wire

    4. Microcatheter 3rd line


    5. Wire “cutting” or puncture
    9. Combinations
    6. Laser 4th line
    7. Atherectomy

    External crush
    8. Subintimal techniques 5th line
    Distal anchor
    Getting support: Guideliner
    “Swan neck” maneuver

    Mamas et al. CCI 2011


    Predilation
    – balloon
    rupture

    next step?

    TIP
    Severe
    calcification
    increases risk for
    perforation
    Unable to
    deliver
    2.80x19 mm

    Graftmaster

    TIP
    Delivery of covered stents
    can be very challenging
    Covered
    stent
    through
    Guideliner

    TIP
    Graftmaster stents can fit
    within an 8 Fr guide
    catheter extension
    Perforation
    sealed
    Second covered stent delivery
    with GuideLiner

    CTOmanual.org – case 89
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    Wire to help
    engagement
    Guide extension to
    help engagement
    Guide extension to
    help engagement of
    anomalous RCA
    Tandem bifurcations
    Balloon assisted
    GuideLiner advancement
    Better visualization
    reveals more clear
    anatomy
    Predilation
    Stent delivery
    Stent deployment
    Final result
    Final result

    Procedural time: 56 min


    Fluoroscopy time: 14.3 min
    AK: 1629 mGy
    Contrast Volume: 220 ml
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    D
    Guide extension

    Courtesy Dr. Roberto Garbo


    Guide extension

    E
    Courtesy Dr. Roberto Garbo
    Guideliner
    Cut Rotablator
    shaft

    entrapped
    burr

    Courtesy Dr. Amir Ravandi


    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    RCA CTO
    Guide extensions can facilitate:

    1. Equipment delivery
    2. Coronary engagement
    3. Thrombectomy
    4. Retrieval of entrapped
    equipment
    5. Reverse CART
    6. ADR
    7. KAM-snare
    How to create a “homemade” snare

    Courtesy: Dr. Kambis Mashayekhi


    How to create a “homemade” snare

    Courtesy: Dr. Kambis Mashayekhi


    Guide extension alternative: deep intubation
    Cannot deliver stent Deep guide intubation
    Stent delivered
    Stent deployed Postdilation
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery: GuideLiner V3
    Balloon
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter Guidewire

    7. Proximal to distal stenting feasible


    8. Compatibility
    Wire-
    Towel
    balloons-
    preventing
    stents
    wrapping of
    wire with
    Guide guide catheter
    catheter extension
    extension push rod
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    How to deliver a
    guide catheter
    extension

    Balloon-assisted
    tracking

    aka

    Inchworming
    TrapLiner
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    BAT: Balloon-
    Assisted Tracking

    Courtesy: Basem Elbarouni, MD


    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    Finn et al. Circ Cardiovasc Interv. 2016;9:e003961
    Finn et al. Circ Cardiovasc Interv. 2016;9:e003961
    Finn et al. Circ Cardiovasc Interv. 2016;9:e003961
    Guide extensions: tips + tricks
    1. Pushrod under towel
    2. Delivery:
    • Inchworming (preferred)
    • BAT, distal anchor
    3. Advance wires under fluoro
    4. Do not advance proximal collar outside guide
    5. Trapping is difficult
    6. Mother-daughter-granddaughter
    7. Proximal to distal stenting feasible
    8. Compatibility
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation
    Equipment deformation/loss

    Brilakis ES. Manual of coronary CTO interventions. Elsevier 2013


    Guide
    extension –
    wire damage
    Telescope
    guide
    extension –
    wire damage
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation
    Deep-seated Guideliner
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation
    Hold your Guideliner during injections!
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation
    CTOmanual.org: case 131

    • On removing Trapliner from pt, device missing from/separated from shaft


    • luckily in tuohy
    Guide extensions: complications
    1. Equipment deformation
    • Advancement
    • Withdrawal
    2. Dissection
    3. Thrombus formation
    4. Distal migration
    5. Fracture
    6. Longitudinal stent deformation

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