Application of a rapid exchange extension catheter technique in type

BACKGROUND In transradial intervention procedures,poor back-up support and noncoaxial alignment of the guide catheter(GC)may result in failure of the balloon or stent to reach the targeted lesion.Methods to provide extra back-up support using the original GC and wire can improve procedural success with reduced complications.A rapid exchange guide extension catheter provides convenient and efficient back-up support while preserving the initial GC and inserted wire.AIM To evaluate the efficacy and safety of rapid exchange extension catheter in the treatment of type B2/C nonocclusive coronary lesions via the radial access.METHODS A total of 135 patients with type B2/C nonocclusive lesions who were treated via the transradial approach were enrolled in the study.The clinical characteristics,indications for use of the rapid exchange extension catheter,and procedural details and results were reviewed and analyzed.All procedure-related complications and major adverse cardiovascular events were recorded during the in-hospital stay and follow-up period.RESULTS The most common indication for the use of a rapid exchange extension catheter was vascular tortuosity(37.8%),followed by heavy calcification(28.9%),long lesions(20.0%),proximal stent(6.7%),in-stent restenosis(5.2%),and coronary origin anomalies(1.5%).The following technologies failed in passing targeted lesions before delivering the rapid exchange catheter:Multiple predilatation technique(57%),buddy wire technique(33.4%),balloon anchoring technique (5.9%), and cutting balloon modification (3.7%). The mean depth of the extensioncatheter intubation was 20.56 ± 13.05 mm, and the mean rapid exchange catheterservice time was 18.9 ± 9.7 min. The mean length and diameter of stents were 33.5± 14.4 mm and 2.75 ± 0.45 mm, respectively. The total rate of technique success(balloon or stent successful crossing of the target lesion with this technique) was94.8%.CONCLUSIONThe rapid exchange extension catheter technique showed acceptable safety andefficacy in the transradial coronary interventions of type B2/C nonocclusivecoronary lesions. We recommend this technique to assist in complex lesionintervention via radial access.

Guiding extension catheter facilitated percutaneous coronary intervention for a dextrocardia patient with acute left anterior descending artery occlusion:a case report

Dextrocardia refers to a right-sided location of the heart within the thoracic cavity which is the primary manifestation of the abnormal lateralisation of the embryonic leftright axis.[1]As a rare cardiac malformation,the prevalence rate of dextrocardia is between 1/6000 to 1/35000 live births.[2]It is reported that the incidence rate of coronary artery disease for dextrocardia patients is similar for patients without dextrocardia.However,the detailed information including electrocardiogram(ECG)manifestation and percutaneous coronary intervention(PCI)technique for dextrocardia patients is still limited.[3,4]Herein,we report a dextrocardia patient who was diagnosed by modified ECG and treated by trans-radial PCI facilitated with guiding extension catheter(GEC).

Long-term outcomes of patients following retrograde chronic total occlusion intervention with Guidezilla reverse controlled antegrade and retrograde tracking(“Guidezilla reverse CART”)technique

Background The Guidezilla reverse controlled antegrade and retrograde tracking("Guidezilla reverse CART")technique has become one of guidewire crossing techniques in current retrograde coronary total occlusion(CTO)percutaneous coronary intervention(PCI),but has received limited study regarding long-term outcomes.Our aim is to investigate procedural and long-term outcomes in a real-world cohort of CTO patients who underwent retrograde PCI with the"Guidezilla reverse CART"technique.Methods Our study included 315 patients who underwent retrograde CTO PCI,with 86 patients treated with"Guidezilla reverse CART"technique(the Guidezilla group)at Guangdong Cardiovascular Institute from January 2015 to December 2017.The median follow-up was 1.9 years.Major adverse cardiac events(MACE)were analyzed using the Kaplan-Meier method,and independent predictors of long-term MACE were determined using a multivariable Cox model.Results Procedural success of the Guidezilla group and non-Guidezilla group were 95.3%and 82.1%,respectively(P=0.003).The procedural complications and in-hospital MACE were similar between both groups.During the 4-year follow-up,27 patients had MACE.Multivariable analysis revealed that the"Guidezilla reverse CART"technique was not associated with worse long-term clinical outcomes[hazard ratio(HR):2.11;95%CI:0.64-6.98,P=0.220].Conclusions The"Guidezilla reverse CART"technique improves the success rate in retrograde PCI of more complex CTOs and is associated with similar complication and in-hospital MACE rates.The"Guidezilla reverse CART"technique is not significantly associated with adverse clinical outcomes.