Robust backup support technique with dual guide extension catheters: a case report.

Abstract

Background: Guide extension catheters are specially designed for percutaneous coronary intervention (PCI) to enhance backup support of the guide catheter by providing coaxial alignment, thereby allowing deep intubation of the catheter. We have developed an innovative auxiliary support technique utilizing a dual guide extension catheter system, designed to enhance safety and facilitate deep coronary artery access.

Case summary: A male in his sixties who presented with chest pain was diagnosed with non-ST elevation myocardial infarction. Percutaneous coronary intervention failed to achieve complete revascularization due to the presence of extensive chronic total occlusion (CTO) in the right coronary artery (RCA). A staged percutaneous intervention was performed to treat the tortuous CTO lesion. Dual guide extension catheters (DGEC), consisting of a 6 Fr Guideplus™ in the 8 Fr GuideZilla II™, were introduced. The Guideplus™ was deeply inserted into the distal RCA through the GuideZilla II™ support. This system provided a stable catheter platform, enabling successful negotiation of the guidewire and delivery of the catheter across the extensive, markedly tortuous segment of CTO of the RCA. Thereafter, the RCA was completely recanalized through stenting and balloon angioplasty following antegrade guidewire penetration. Subsequently, enhanced backup force of the DGEC was demonstrated through in vitro force gauge testing, suggesting that this novel technique might be promising for interventions for CTO in vessels with severe tortuosity.

Discussion: The DGEC system facilitates substantial guide catheter backup support in the context of PCI for severely tortuous total occlusive disease.