![]() In vitro experiments using a coronary artery tree model demonstrated that backup support with the 4-in-6 method was similar to that achieved with a 6-Fr guiding catheter. Because these stents could not be retrieved, they were deployed or crushed at nontarget coronary segments.Īnother issue is that the small diameter of the 4-Fr child catheter prevents the use of IVUS and some stent or balloon types. Two instances of stent dislodgment occurred during withdrawal of the stent delivery system into the child catheter. The main obstacles to procedural success were severe calcification and tortuosity of either the proximal segment or target lesion. Overall, 94% of patients not only had their lesions crossed but also were free of in-hospital MACE including cardiac death, MI, and TLR. Stent deployment was attempted in 44 cases (86%), of which 40 were successful (91%). In these formerly resistant lesions, the mother-child technique achieved target lesion percent diameter stenosis of less than 50% in 48 lesions (94%). A minority of lesions were type B2 (18%). By far, the most common lesion morphology was type C (82%). The majority of vessels treated were right coronary (41%), followed by left anterior descending (33%), circumflex (22%), and bypass grafts (4%). The technique was chosen at operator discretion when previous attempts at conventional PCI failed to cross the lesion. Satoshi Takeshita, MD, of Shonan Kamakura General Hospital (Kamakura, Japan), and colleagues looked at 51 consecutive patients who underwent PCI via the mother-child technique using a 4-Fr catheter (manufactured both by Terumo and Asahi Intecc). The “4-in-6” system may become a viable alternative for highly calcified, angular, or tortuous lesions, according to a paper published online March 1, 2011, ahead of print in Circulation: Cardiovascular Interventions. Inserting a 4-Fr catheter into a 6-Fr guiding catheter-the so-called mother-child technique-greatly improves the success rate for treating lesions in which standard methods have failed. ![]() With this case, we illustrate that this microcatheter dramatically improves the back-up support, allowing stent deployment also in very difficult settings as in tortuous LIMA grafts.Download this article's Factoid (PDF & PPT for Gold Subscribers) After multiple failed attempts to cross the LAD lesion with conventional stent deployment techniques, we successfully finished the stenting procedure using the Guideliner microcatheter (Vascular Solutions) as a guiding extension through the LIMA graft. ![]() We report a case of a challenging PCI of the LAD through a patent and disease-free LIMA graft. Improving back-up support during LIMA-LAD PCIs is often challenging because in this particular setting the distance between the LAD lesion and the guiding catheter is exceedingly long. Left anterior descending (LAD) artery PCI through the left internal mammary artery (LIMA) are rarely performed because many operators feel reluctant to instrument a disease-free LIMA graft risking iatrogenic complications by passing wire, balloons, and stents to the diseased distal LAD. Extra back-up support guiding catheters, deep intubation, buddy wires, and other more complex techniques are usually used to improve this support. Back-up support during percutaneous coronary interventions (PCI) is one of the keys for successful intervention. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |