Previous reports showed that GuideLiner (GL) and Guidezilla (GZ) can accommodate bulky and multiple devices beyond the official profiles. However, feasibility of kissing balloon technique (KBT) through these devices is unknown. The tested devices included 7Fr-GL/GZ and respective three types of 2.5 mm semi-compliant (SC) and non-compliant (NC) balloons: conventional model (CM), tapered-tip model (TM) and latest model (LM). First, three experienced operators attempted to advance all 21 combinations of the 2 balloons through GL/GZ on the guidewires and assessed the crossability in 3 grades: easy, difficult and impossible. Second, the only balloon combinations graded as easy by all operators were tested in the polyurethane-made bifurcation model which required KBT following cross-over stenting. Within the total of 42 device combinations, only one balloon combination of double LM–NC balloons was classified as easy in both GL/GZ by consensus opinion of the operators. While two combinations of LM–SC and LM–SC/NC balloons were classified as difficult in both GL/GZ, all four combinations of LM–SC/NC and CM/TM–NC balloons were classified as difficult only in GL. Other 32 combinations were all classified as impossible. In the bifurcation model, the combination of double LM–NC balloons using GL achieved KBT while the same balloon combination with GZ failed. The feasibility of KBT using child-catheter is highly dependent on the device characteristics. The combination of latest small-profile NC balloons through GL could be clinically applicable.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Chan PH, Alegria-Barrero E, Foin N, Paulo M, Lindsay AC, Viceconte N, et al. Extended use of the GuideLiner in complex coronary interventions. EuroIntervention. 2015;11:325–35.
Waterbury TM, Sorajja P, Bell MR, Lennon RJ, Mathew V, Singh M, et al. Experience and complications associated with use of guide extension catheters in percutaneous coronary intervention. Catheter Cardiovasc Interv. 2016;88:1057–65.
Fabris E, Kennedy MW, Di Mario C, Sinagra G, Roolvink V, Ottervanger JP, et al. Guide extension, unmissable tool in the armamentarium of modern interventional cardiology. A comprehensive review. Int J Cardiol. 2016;222:141–7.
Sharma D, Shah A, Osten M, Ing D, Barolet A, Overgaard CB, et al. Efficacy and safety of the guideliner mother-in-child guide catheter extension in percutaneous coronary intervention. J Interv Cardiol. 2017;30:46–55.
Yoshida R, Ishii H, Morishima I, Tanaka A, Takagi K, Iwakawa N, et al. Impact of adjunctive use of guide extension catheter for mid-term outcome of drug-coated balloon. EuroIntervention. 2019. https://doi.org/10.4244/eij-d-18-01013[Epub ahead of print].
Vishnevsky A, Savage MP, Fischman DL. GuideLiner as guide catheter extension for the unreachable mammary bypass graft. Catheter Cardiovasc Interv. 2018;92:1138–40.
Naganuma T, Ishiguro H, Panoulas VF, Fujino Y, Mitomo S, Kawamoto H, et al. Which child catheter should we choose to deliver a bulky bioresorbable vascular scaffold? Int J Cardiol. 2016;203:781–2.
Fujimoto Y, Tonoike N, Kobayashi Y. Successful delivery of polytetrafluoroethylene-covered stent using rapid exchange guide extension catheter. Cardiovasc Interv Ther. 2017;32:142–5.
Warisawa T, Goto S, Salazar CH, Akashi YJ, Escaned J. Safety and feasibility of coronary lithotripsy supported by guide extension catheter for the treatment of calcified lesion in angulated vessel. Cardiovasc Revasc Med. 2019. https://doi.org/10.1016/j.carrev.2019.02.014.
Warisawa T, Naganuma T, Nakamura S. Off-label use of 7Fr GuideLiner in the bifurcation coronary intervention protecting 2 side branches. Cardiovasc Interv Ther. 2017;32:392–5.
Shikuma A, Shiraishi J, Koshi N, Matsubara Y, Nishimura T, Shoji K, et al. bifurcation intervention in single coronary artery. Int Heart J. 2018;59:1458–61.
Warisawa T, Ishiguro H, Nakajima A, Nakamura S. Novel ‘‘baby-in-mother’’ technique with the GuideLiner in the bifurcation coronary intervention with the protect-wire kept in the side branch. Cardiovasc Interv Ther. 2017;3:254–8.
Conflict of interest
TW reports consultancies work for Abbott Vascular and Philips. All other authors report no conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Warisawa, T., Kuwata, S., Kasahara, M. et al. Feasibility of kissing balloon technique through guide extension catheters: an experimental bench test. Cardiovasc Interv and Ther 35, 269–275 (2020). https://doi.org/10.1007/s12928-019-00622-9
- Guide extension catheter
- Kissing balloon inflation