Author + information
- Divyesh Sharma,
- Ashish H. Shah,
- Peter Seidelin,
- Christopher Overgaard,
- Douglas Ing,
- Mark Osten,
- Alan Barolet and
- Vladimir Dzavik
With advancement in technology, percutaneous coronary interventions (PCI) are increasingly performed on complex coronary lesions via trans-radial approach (TRA). Various techniques have been described to overcome the difficult coronary anatomies. In the present study, we aim to evaluate the indications, procedural outcome and associated complications with GuideLiner use, in treating complex lesion via TRA.
We collected data from all the patients, in whom the GuideLiner was used to facilitate PCI between April-2011 to December-2014 at the Toronto General Hospital. Demographic and procedural data including indications for the GuideLiner use, procedural outcome and associated complications were collected from the institutional prospective data registry. Quantitative coronary angiography was used to determine the intubation depth of the GuideLiner catheter.
Procedural success was defined as < 20% stenosis after stent implantation and TIMI-3 flow at the end of procedure. Device success with GuideLiner was defined as ability to deliver balloon or stent to the desired position. The conversion from radial to femoral, if required, was also recorded.
During the study period, 6105 PCIs were performed at our institution. Out of these, GuideLiner was used in 307 patients (317 lesions). In our cohort, 82% were male with a mean age of 68.4±11.2 years. Hypertension (74.3%), dyslipidemia (53.7%) and diabetes (39.1%) were commonest cardiovascular risk factors. Prior MI (28%), previous PCI (37.8%) or CABG (24.8%) was noted in our cohort. Majority of lesion were type B2 or C (98%), calcified (86.3%), or the ones with proximal tortuosity (88.6%). Stent delivery (64.2%) was the most common indication for the GuideLiner use. The overall technical success rate of GuideLiner was 88%. The procedural success rate in this cohort was high at 98.7%. Stent dislodgement (0.6%, n=2), longitudinal stent deformation (0.3%, n=1) and coronary dissection (0.3%, n=1) were the complications observed. The conversion to femoral access was required in only 3 patients (1%) in our cohort.
Use of GuideLiner facilitated successful completion of PCI procedure in majority (88%) of patients with complex lesions via transradial approach.