Differences in primary indication for guide-extension catheter usage among the three target vessels

Introduction

During complex percutaneous coronary intervention (PCI), one of the biggest challenges is the inability to cross devices to the target lesions [1]. The buddy wire and anchoring balloon technique can be helpful in such situations [2, 3]. The mother-in-child technique is another powerful method [4, 5]. Applying a similar concept, the rapid-exchange guide extension catheter (GEC) has been evolving. Previous studies have proposed a mechanism of its efficacy as increasing back-up support by deep intubation, as a conduit to decrease friction between the vessel wall and the catheter, or for improving co-axial alignment between the catheter and the lesion [6, 7]. However, little is known regarding the differences in primary indication with respect to the target vessels.

Aim

The purpose of this study was to clarify the primary indication for GEC according to the target vessels and to provide thorough consideration of the mechanistic effect of GEC.

Material and methods

We enrolled 232 consecutive patients with 251 lesions (excluding left main and bypass-graft lesions) for whom GEC-facilitated PCI was performed between March 2014 and September 2018. Those who participated in another study were excluded [8]. The research review board of our hospital approved this study, which complied with the Helsinki Declaration. All patients provided consent for participation in this study.
GuideLiner V3 (Vascular Solutions Inc., Minneapolis, MN, USA), Guidezilla (Boston Scientific, Marlborough, Massachusetts, USA), or GuidePlus (Nipro Corp., Osaka, Japan) was used. The primary indication for GEC was defined as follows [6, 7]: 1) to increase back-up support; 2) as an outer sheath; 3) to facilitate co-axial alignment between the catheter and the lesion; 4) to selectively inject contrast; and 5) other. Although the complete differentiation among the indication of 1)–3), especially between 1) and 2), was hard to achieve, we defined the indication of 1)–3) as follows: the indication of 1) was defined in cases where the operators simply would like to increase backup support of a guiding catheter to facilitate delivering stents or a balloon with little awareness of the tortuosity or angle of the vessel proximal to the target lesion; indication of 2) was defined in cases where the GECs have passed beyond the lesions and the devices were delivered; indication of 3) was defined in cases where the tortuosity or acute bending proximal to...


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