Abstract
The extension support guiding catheter has been used to perform complex percutaneous coronary intervention to increase back-up support for the guiding catheter or to ensure deep intubation for device delivery. However, because of its monorail design, advancement of the stent into the distal extension tubing segment is sometimes problematic. Although this problem is considered due to simple collision of the stent, operators have observed tangling between a monorail extension catheter and coronary guidewire in some patients. To examine movement of the collar of the extension guide catheter during advancement of the guiding catheter, we set up an in vitro model in which the guiding catheter had two curves. Rotation of the extension guide catheter was examined by both fluoroscopic imaging and movement of the hub of the proximal end of the catheter. During advancement in the first curve, the collar moved toward the outer side of the curve of the guiding catheter as the operator pushed the shaft of the extension guiding catheter, which overrode the guidewire. After crossing the first curve, the collar moved again to the outer side of the second curve (the inner side of the first curve) of the mother catheter, and then, another clockwise rotation was observed in the proximal hub. Consequently, the collar and tubing portion of the extension guide catheter rotated 360° around the coronary guidewire, and the monorail extension catheter and guidewire became tangled. There is a potential risk of unintentional twisting with the guidewire during advancement into the curved guiding catheter because of its monorail design.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mamas MA, Fath-Ordoubadi F, Fraser DG. Distal stent delivery with Guideliner catheter: first in man experience. Catheter Cardiovasc Interv. 2010;76(1):102–11.
Takeshita S, Takagi A, Saito S. Backup support of the mother–child technique: technical considerations for the size of the mother guiding catheter. Catheter Cardiovasc Interv. 2012;80(2):292–7.
Cola C, Miranda F, Vaquerizo B, Fantuzzi A, Bruguera J. The Guideliner™ catheter for stent delivery in difficult cases: tips and tricks. J Interv Cardiol. 2011;24(5):450–61.
Alkhalil M, et al. Did the use of the Guideliner V2™ guide catheter extension increase complications? A review of the incidence of complications related to the use of the V2 catheter, the influence of right brachiocephalic arterial anatomy and the redesign of the V3™ Guideliner and clinical outcomes. Open Heart. 2016;3(1):e000331.
Murphy JC, Spence MS. Guideliner catheter—friend or foe? Catheter Cardiovasc Interv. 2012;80(3):447–50.
Waggoner T, Desai H, Sanghvi K. A unique complication of the GuideZilla guide extension support catheter and the risk of stent stripping in interventional & endovascular interventions. Indian Heart J. 2015;67(4):381–4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
The authors declare no financial relationships or conflicts of interest regarding the content herein.
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human rights
The study was performed in accordance with the ethical standards of the Sakurakai Takahashi Hospital Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments.
Informed consent
The patient gave his written informed consent to publish his case and accompanying images.
Rights and permissions
About this article
Cite this article
Hashimoto, S., Takahashi, A., Yamada, T. et al. Spontaneous rotation of the monorail-type guide extension support catheter during advancement of a curved guiding catheter: the potential hazard of twisting with the coronary guidewire. Cardiovasc Interv and Ther 33, 379–383 (2018). https://doi.org/10.1007/s12928-017-0500-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12928-017-0500-y