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Anouska Moynagh, Philippe Garot, Thierry Lefèvre and Yves Louvard
American Heart Hospital Journal Volume 9 No.1

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In this report, we describe two cases of transradial intervention of chronic total occlusions assisted by the GuideLiner catheter when the guide catheter support was suboptimal. This novel coaxial system can provide additional support for more complex lesions and, in our cases, allowed the procedure to be completed via the transradial approach rather than having to change to transfemoral access.

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The transradial approach (TRA) is emerging as a successful method for coronary intervention. It provides the additional benefits of earlier ambulation, a reduction in staff workload, and, most importantly, a reduction in the rate of access site complications, when compared with the transfemoral approach (TFA).^1-5 However, it also has limitations. Owing to the smaller size of the radial artery, the choice of guiding catheter (GC) size is limited, with the maximal acceptable diameter being 6 Fr in the majority of cases and as a result back up support is compromised.⁶A number of techniques have been used in order to try to improve the support.^7-11 Recently, the 'mother-and-child' technique, using a five-in-six system, has emerged as a powerful tool to increase back-up support.¹¹

The GuideLiner™ (Vascular Solutions, Inc., Minneapolis, MN) (see Figure 1 and 2) catheter is a new coaxial motherand- child guide extension. After crossing the lesion with a conventional guide wire (GW), the GuideLiner is used as an inner catheter and inserted inside the 6 Fr GC, creating a mother-and-child system, and can be used to intubate the coronary artery. This improves the back-up support and allows selective deep intubation in difficult coronary cases enabling easier balloon and/or stent crossing.^11-13 In this report we show our first experiences of the GuideLiner catheter in two consecutive cases of chronic total occlusions of the right coronary artery in which the device was able to solve the technical difficulties associated with these complex procedures.

Case Report
Case One
A 53-year-old man presented with class two stable angina. Cardiovascular risk factors included hypertension, dyslipidemia, and a history of smoking. Coronary angiography revealed a chronic total occlusion (CTO) of the mid right coronary artery (RCA) with collateralisation from the left system. Subsequent cardiac magnetic resonance imaging (MRI) revealed inferolateral ischemia with viability in this territory. The decision was made to proceed with percutaneous coronary intervention (PCI) of the RCA.

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• Correspondence: Yves Louvard, MD, FSCAI, Institut Hospitalier Jacques Cartier, 6 rue du Noyer Lambert, 91300 Massy, France. E: y.louvard@icps.com.fr