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Seesaw double GuideLiner® catheter technique for a successful bail-out procedure from blow-out type coronary
Takeshi Sugimoto1, Tetsuya Nomura2, Daisuke Miyawaki2
1Department of Cardiovascular Medicine, Nantan General Hospital, 25 Yagi-Ueno, Yagi-cho, Nantan, Kyoto, 629-0197, Japan. takeshi.sugimoto15@gmail.com.
Insights
This case study details a novel technique for managing coronary artery perforation during a procedure. Using two guiding catheters (GC) with GuideLiner® catheters, clinicians achieved hemostasis and deployed a covered stent.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery perforation is a rare but serious complication during percutaneous coronary interventions.
- Calcified stenosis in the left anterior descending artery presents unique challenges for procedural success.
Observation:
- A case of blow-out type coronary perforation occurred at a calcified stenosis of the left anterior descending artery.
- Initial management involved balloon tamponade via a guiding catheter (GC) and a GuideLiner® catheter.
Findings:
- A second GC with a GuideLiner® catheter was introduced to deploy a covered stent.
- The dual GC and GuideLiner® system enabled simultaneous balloon tamponade and stent delivery.
- A seesaw-like manipulation of the GuideLiner® catheters minimized interruption of tamponade.
Implications:
- This technique offers a viable strategy for managing complex coronary perforations.
- The dual GuideLiner® approach enhances procedural safety and efficiency in high-risk interventions.
- Minimizing procedural interruptions is crucial for patient outcomes in emergent situations.
Abstract:
We encountered a case of blow-out type coronary perforation at the calcified stenosis of left anterior descending artery. First, we started immediate balloon tamponade through the initial guiding catheter (GC) with a GuideLiner® catheter. Next, we introduced a second GC with a GuideLiner® catheter and successfully deployed a covered stent. Two sets of the GC with GuideLiner® catheter facilitated us to simultaneously perform temporary hemostasis with balloon tamponade and rapid delivery of a covered stent. To alternately manipulate the GuideLiner® catheters, back and forth with seesaw-like motion enabled us to minimize the interruption of balloon tamponade.
