Guide catheter extension systems: Hype or a need?

Abstract

Guide catheter extension system (GCES) is a valuable tool for interventional cardiologists, especially in complex cases. GCES increases guide back-up support and is crucial in complex PCI procedures, particularly in cases of severe calcification and tortuosity. Apart from their primary use to increase back-up support of guide by providing coaxial alignment, deep intubation and facilitation of stent delivery, GCES are now being increasingly used in different clinical indications including complex and high-risk coronary intervention interventions.

Guide Extension Catheter-assisted Interventions - A Single-Centre Experience

“…Globally, at least seven guide extension catheter systems are available, but only three of them are commercially available in India [GuideLiner V3 Catheter (Teleflex, USA), Guidezilla II Guide Extension Catheter (Boston Scientific, USA), and Telescope Guide Extension Cathete] with limited use in small number of centers. [3] In the present study, we used the Guidezilla II Guide Extension Catheter for all the patient, and we reported a 100% procedural success rate. Similarly, a recent study reported 98.7% procedural success rate with the GuideLiner catheter to in 317 complex lesions.…”

“…Among many causes of procedural failure, failure to deliver equipment (stent/balloon/ thrombosuction device/rotablation catheter/ coils etc.) is frequent [1,3]. Poor back-up force, poor axial alignment (increased friction between stiff stent and vascular wall), and increased tortuosity of the target vessel are the major causes of equipment delivery failure.…”

“…In the aforementioned complex lesions, guide extension catheter is frequently employed to increase backup support and guide catheter alignment for stent delivery with reported success rate of about 90%. [3] Therefore, in the present study, we assess the technical and procedural success and safety of guide extension catheter in challenging and complex PCI and carotid intervention cases.…”

Guidezilla™ guide extension catheter I for transradial coronary intervention

“…At present, the main indications for GGEC I use are: (1) anomalous origin or angulated take-off of native coronary arteries; (2) extremely tortuous vessel; (3) heavy calcification; (4) distally located lesion; (5) picking up the retrograde wire during CTO intervention; (6) releasing the burr incarceration ( 11 , 30 , 31 ). In the present study, the main indications were heavy calcification (67%) followed by extreme tortuosity (12.2%), extreme tortuosity and heavy calcification (10.9%), distally located lesion (4.5%), picking up the retrograde wire when using the active greeting technique (AGT, 3.2%), anomalous origin of the vessel (1.8%), and to release the burr incarceration (0.4%).…”

“…In the present study, the main indications were heavy calcification (67%) followed by extreme tortuosity (12.2%), extreme tortuosity and heavy calcification (10.9%), distally located lesion (4.5%), picking up the retrograde wire when using the active greeting technique (AGT, 3.2%), anomalous origin of the vessel (1.8%), and to release the burr incarceration (0.4%). In addition, the GGEC I is usually used for remedial purposes, which inevitably leads to longer operation time, higher radiation exposure dose, and higher contrast agent dosage ( 11 , 31 , 32 ). Still, the results of the SYNTAX I score stratification in this study indicate that the SYNTAX score was beneficial in guiding the revascularization strategy, and anatomical characteristics were more significant in the successful treatment of a single target vessel.…”