“ Mother and Child” Classically used Terumo Heartrail 125cm guide 5F through standard 6F (Cordis/Medtronic/Boston etc) guide Guide catheter backing out resistance to stent passage causes guide to back out –backup is lost as guide comes away from coronary osteum & aortic wall

Support from conventional JR4 guide JR4 guide limited support from contact with opposite aortic wall Solutions Support guide -  force before displacement Support / buddy wire - reduce tortuousity Lesion preparation / lower profile stent -  friction Īdditional techniques Distal anchor balloon  backup support by locking guide requires  7F to accommodate inflated balloon + stent may increase friction (2 catheters in lesion) ĭistal anchor balloon – JR4 guide Balloon inflated in distal vessel Guide locked in position allowing increased force on stent before displacement Need  7F Stent catheter advanced through proximal obstructionĪdditional Techniques Guide catheter extension Greatly increases back-up support Shape modification ‘Amplatzing’  contact in aorta Deep intubation increases contact within the coronary artery May traverse proximal obstruction more flexible than a stent Can be advanced using distal anchor balloon Requires only 6F without need for 2 catheters in lesion Can be advanced through proximally deployed stents Permits proximal to distal stenting ĭifficulties encountered during SVG-PCI include: Inadequate Guide Catheter Support Inability to reach ostium and cannulate SVG Competitive Flow Achieving deep seating of guide catheter in SVG Extreme Tortuosity SVG PCI SVG PCI SVG PCI accounts for between 5-10% of PCI procedures SVG PCI procedures technically more challenging than native coronary arteries Previous CABG shown to increase failure rate of trans radial PCI procedures 7-fold. Optimization of Guide Catheter Support: What are my Options? David Meerkin Director of Experimental Cardiology Shaare Zedek Medical Center Jerusalemįailure to deliver a stent is a frequent cause of procedural failure Factors Poor back up  force before guide displacement Tortuousity  distal transmission of force Friction between rigid stent and vessel wall Conventional PCI

Guideliner interventional