FIGURE 1
CLINICAL CASE
GUIDELINER®, SUPERCROSS™
& TURNPIKE® CATHETERS
Successful Use of the GuideLiner V3,
SuperCross AT and Turnpike
Catheters in Multi-Vessel PCI
PHYSICIAN
FIGURE 2
Farrel Hellig, BSc, MBBCh, FCP(SA), FSCAI
Sunninghill Hospital, Johannesburg, South Africa
PRESENTATION
The patient presented with hypertension, peripheral vascular
disease, prior carotid endarterectomy, dyslipidemia and
Parkinson’s disease. The patient also presented with Class III
stable angina and severe lifestyle limitation.
FIGURE 4
FIGURE 3
INITIAL FINDINGS
Coronary angiography revealed severe multi-vessel disease
and heavy calcification combined with tortuosity. Lesions
were found in the distal left main, proximal LAD, proximal
circumflex, ramus and right coronary arteries. The right
coronary artery was non-dominant, supplying a small territory.
The patient had a normal LV ejection fraction (Figure 1).
TREATMENT
The LCA was engaged with a 7F EBU 3.75 guiding catheter and
the LAD was wired with a RotaWire™ guidewire. Atherectomy
was performed in the LAD with a 1.5mm burr, requiring
considerable burring. A BMW™ guidewire was then placed
and a Hiryu® 3 x15mm balloon catheter at 20atm was used to
dilate the LAD. Balloon dilation was followed by placement of
a Xience Pro 3 x 18mm stent deployed at 22atm. The ramus
was then wired with a Fielder® FC guidewire and exchanged
for a rotablator wire using a Turnpike catheter and the same
burr used to ablate the ramus. Atherectomy was followed by
stenting with a Xience Pro 2.75 x 12mm stent deployed at
22atm (Figure 2).
The AV circumflex arose just proximal to the ramus lesion. A
SuperCross 90° Angled Tip microcatheter made it possible
to wire the 90° angle AV groove circumflex with a Fielder FC
guidewire (Figure 3).
(continued on back)
FIGURE 5
TREATMENT (CONTINUED)
The Fielder FC was exchanged for a Hi-Torque® Wiggle
guidewire and successful predilatation was performed with a
Cape Cross 2 x 10mm balloon catheter (Figure 4).
Stent delivery was extremely challenging and could only
succeed with the assistance of a GuideLiner catheter. A 2.25 x
12mm Synergy™ stent was placed in the ostium of this vessel
and a 2.25 x 8mm Synergy stent was placed just distally with
an optimal result (Figure 5).
FIGURE 6
Using a 4 x 16mm Synergy stent deployed at 24atm, the left
main was then stented directly from the ostium to the distal
left main with an optimal final result (Figure 6).
CONCLUSION AND POST PROCEDURE
The patient exhibited complete angina resolution at follow-up
with normal stress ECG (Figure 7).
SUMMARY
FIGURE 7
RotaWire delivery in the ramus was only possible after
wiring the vessel with a Fielder FC guidewire first and then
exchanging for a RotaWire using a Turnpike catheter. Wiring
of the extreme angulation of the diseased ostium of the
circumflex could only be achieved using the SuperCross 90°
Angled Tip microcatheter. Stent delivery to the tortuous,
calcified circumflex was made possible by the added support
from a 6F GuideLiner catheter.
Farrel Hellig BSc, MBBCh, FCP(SA), FSCAI
Cath Lab Director of Sunninghill Hospital in
Johannesburg, South Africa
Director of AfricaPCR
GuideLiner catheters are intended to be used in conjunction with guide catheters to access discrete regions of the coronary and/
or peripheral vasculature, and to facilitate placement of interventional devices. The GuideLiner catheters are contraindicated in
vessels less than 2.5mm in diameter and in vessels in the neurovasculature or the venous system.
The Turnpike catheters are intended to be used to access discrete regions of the coronary and/or peripheral vasculature. They may
be used to facilitate placement and exchange of guidewires and to subselectively infuse/deliver diagnostic and therapeutic agents.
The Turnpike Spiral and Turnpike Gold catheters are contraindicated for use in vessels with an effective diameter smaller than 1mm.
The SuperCross microcatheters are intended to be used in conjunction with steerable guidewires to access discrete regions of
the coronary and/or peripheral vasculature. They may be used to facilitate placement and exchange of guidewires and other
interventional devices and to subselectively infuse/deliver diagnostic and therapeutic agents. The SuperCross microcatheter is
contraindicated for high pressure injections and for use in the cerebral vasculature.
Please see the Instructions for Use for a complete listing of the indications, contraindications, warnings and precautions.
CAUTION: Federal law (U.S.A.) restricts this device to sale by or on the order of a physician.
GuideLiner and Turnpike are registered trademarks and SuperCross is a trademark of Vascular Solutions, Inc. All other trademarks
and registered trademarks are property of their respective owners.
©2016 Vascular Solutions, Inc. All rights reserved. ML3188 Rev. A 04/16
Vascular Solutions, Inc.
6464 Sycamore Court North
Minneapolis, Minnesota 55369 USA
Customer Service:
United States: 888.240.6001
International: (001) 763.656.4298
[email protected]
www.vasc.com