![]() It is compatible with standard guiding catheters (except those with a conical tip) and its lumen is 1 Fr smaller than that of the catheter utilized. In addition, it provides an extension to the guiding catheter that, on occasion, makes it possible to gain access to the ostia of hard-to-reach coronary arteries or coronary bypass grafts. The flexible design of the catheter and the absence of a distal primary curve permit deep and theoretically atraumatic intubation of the coronary tree, increasing guiding catheter support, which enables selective injections and reduces the amount of contrast medium employed. It has a distal end of 20cm, consisting of a flexible extension with a radiopaque marker situated 2.7mm from the tip and a coaxial exchange system 20cm from the tip, joined to a 125-mm compact metal hypotube by means of a ring ( Figure 1). The GuideLiner ® catheter (Vascular Solutions Inc., Minneapolis, Minnesota, United States) is a coaxial “mother and child” catheter, mounted on a monorail system, that extends the angioplasty guiding catheter and enables deep intubation of the coronary artery to achieve extra support and improve coaxial alignment. Deep intubation of the coronary artery is another of the strategies, but is limited by the possible occurrence of the dissection of proximal plaques or total occlusion of the vessel during maneuvers of this type. In complex angioplasty procedures of this type, different strategies have been emerging to resolve the problem of inadequate guiding catheter support, including the use of high-support guide wires and techniques involving buddy wires, buddy balloons, or anchoring balloons (inflation of an anchoring balloon in side branches). The final angiogram showed successful result.Stent placement frequently poses considerable difficulty in coronary interventions, especially in tortuous or calcified arteries and chronic occlusions this is evidenced by the fact that failed stent deployment still occurs in 2.7% to 3.3% of the interventions undertaken. We added Promus Premier 3.5x16mm at the injured site. We thought that it was because of the Guideliner catheter injury. After that, the angiogram revealed dissection and hematoma at proximal RCA. ![]() Then we deployed 2 stents separately at mid RCA, Promus Premier 3.0x16mm, 3.0x12mm. We could deliver Promus Premier® 2.25x32mm at posterolateral branch. After that we could get enough back up force to deliver the stent to the distal RCA. And then we progressed Guideliner to mid RCA with the help of anchoring technique which stabilized the guiding catheter by the 2.5mm balloon. ![]() At first we delivered Traveler® 2.5x15mm to posterolateral branch and dilated the lesion. We thought that we could “short cut” the severest tortuosity part, proximal RCA, by using the catheter. It is easier to use than conventional child catheter. After that, we used a Guideliner® a rapid exchange type child catheter. Sion®(Asahi) a0.014 inch wire could not cross the lesion without the help of Finecross® a micro catheter. The catheter can make a powerful back up by contacting with contralateral aortic wall with an aspect. We selected Profit RU 3.75®(GOODMAN) a special back up catheter for RCA. Before the procedure, we expected this PCI would require powerful backup force because of severe tortuosity and calcification. We performed PCI to RCA via right radial approach and 6 Fr short sheath was inserted.
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