During the attempt to cross the first curve with the 3.5/20 mm Pro-Kinetic™ Energy stent (Biotronik – Bulach, Switzerland), the stent broke free in the proximal third of the right coronary artery. Stenosis pre-dilation was then performed with a 2.5/12 mm Trek™ balloon (Abbott Vascular – Santa Clara, CA, USA). The extensive manipulation caused kinking in the Export™ catheter proximal to the target stenosis. It was not possible to advance the Export™ 6 F thrombus aspiration catheter (Medtronic – Minneapolis, MI, USA), even with the aid of a second 0.014 inch BHW guidewire (buddy wire). The stenosis was corrected with a 0.014 inch BHW guidewire (Abbott Vascular – Santa Clara, CA, USA). The right coronary artery was cannulated with an AL1 6 F guide catheter (Medtronic – Minneapolis, MI, USA), through which an intracoronary infusion of abciximab was administered. The circumflex artery was occluded and the anterior descending artery had 40% stenosis. Coronary angiography via the right radial artery revealed a calcified and tortuous right coronary artery with 90% stenosis and a negative image suggestive of a thrombus in the proximal third of the artery. CASE REPORT Case 1Ī 72-year-old male patient was admitted with post-myocardial infarction of the inferior wall angina. The use of the GuideLiner™ in three procedures is described. The catheter can be introduced through the ‘Y’ haemostatic valve and must be advanced over the 0.014 inch guidewire, thus working as a rapid-exchange balloon catheter. The GuideLiner™ decreases the diameter of the ‘mother’ guide catheter by 1 F (the inner diameter of the GuideLiner™ 6 F is equal to 5 F = 0.056 inch/1.42 mm) and is available in 6 F, 7 F, and 8 F diameters. The distal tube has a radiopaque marker at a distance of 2.7 mm from the distal tip and two external markings: a single mark that is 95 cm from the proximal extremity and a pair of marks 105 cm from the proximal extremity. The catheter is 145 cm long, with a stainless steel strut connected to the distal tube by a metal collar. It has a highly flexible 20-cm distal extremity, a polytetrafluoroethylene (PTFE) internal coating, a metal coil structure in the centre, and an outer coating of Pebax® (Arkema – Colombes, France) with silicone lubrication. The GuideLiner™ (Vascular Solutions – Minneapolis, KS, USA) is a modified ‘child’ type rapid exchange guide catheter extension that provides excellent support, selective intubation, and coaxial alignment.
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