The GuideLiner may be a useful adjunct for rotablation when the rotating burr cannot cross a tight, calcified stenosis and more support is needed. It is prudent to avoid large burrs because of the risk of entrapment in the GuideLiner. Caution is needed to position the burr distal to the GuideLiner before starting any forward rotation to avoid potential damage and shear of the “child” catheter. However, its use to deliver the rotablation burr (3) is off-label and has been reported only once (4). The GuideLiner has been previously used to retrieve a trapped rotaburr (2). The GuideLiner is a guide catheter extension used for the “mother-and-child” technique, which improves support through deep intubation of the target vessel and thus facilitates delivery of stents in tortuous or calcified vessels (1). The PCI was completed with standard techniques, with excellent results ( Figure 1C). VASCULAR SOLUTIONS GUIDELINER V2 CATHETER: Back to : Model Number 6F: Device Problem Material Separation (1562) Patient Problem No Information (3190) Event Date : Event Type Injury Event Description Failure of guide liner with a wire separating from the liner portion of the device as device was removed from the pt body. This maneuver obviously “stiffened” the guide catheter-rotawire-rotablation catheter assembly and enabled the rotating burr to cross the heavily calcified stenosis. We eventually managed to rotablate the calcified stenosis after we advanced a 6-F GuideLiner (“mother-and-child” technique) (Vascular Solutions Inc., Minneapolis, Minnesota) proximal to the stenosis ( Figure 1B, Online Video 3). However, we were initially unable to cross the stenosis with the rotating 1.25-mm burr. We used a left femoral access, a long sheath, and an Amplatz Left 1 guide catheter (Boston Scientific, Natick, Massachusetts) to optimize support. Final result after right coronary artery stent deployment (left anterior oblique view) ( Online Video 3). (C) Right coronary angiogram post rotational atherectomy. Excellent visualization of the lesion was obtained following deep intubation of the left circumflex with a 6F GuideLiner ( Fig. Rotaburr crossing the lesion with the support of the GuideLiner (left anterior oblique view) ( Online Video 2). We eventually managed to rotablate the calcified stenosis after we advanced a 6-F GuideLiner (mother-and-child technique) (Vascular Solutions Inc. (B) Rotational atherectomy supported by the GuideLiner. Tight calcified stenosis in the midportion of the right coronary artery (left anterior oblique view) ( Online Video 1). (A) Right coronary angiogram pre-rotational atherectomy. GuideLiner-Facilitated Rotational Atherectomy in Calcified Right Coronary Artery
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