![]() ![]() ![]() A 1.25 mm burr was advanced through the GuideLiner and easily negotiated the acute takeoff angle of the left circumflex artery (Figure 1(c)). A 2.5 balloon was used to dilate and anchor in the midleft circumflex artery to facilitate advancement of the GuideLiner to that position. Unfortunately, a 2.25 noncompliant Quantum balloon (Boston Scientific, Natick, MA, USA) was unable to dilate the calcific lesion at high pressure (Figure 1(b)). sheath and the left main artery was engaged with an XB 3.5 7 Fr. Percutaneous coronary intervention (PCI) using the right transradial approach was performed. The angle of the left circumflex (LCx) artery takeoff from the left main was greater than 90 degrees and its proximal segment had significant calcification as well. Coronary angiography revealed severe 90% proximal OM2 stenosis and a severe calcific 90% stenosis in the OM3 (Figure 1(a)). Case Number 1Ī 67-year-old male with known diabetes, hypertension, dyslipidemia, and previous acute inferior STEMI with previous percutaneous intervention of the RCA and PDA presented with CCS class III angina symptoms refractory to maximal medical therapy. To our knowledge, this is the only reported case of using a Rotablator within a GuideLiner. We describe 3 cases in which the passage of the GuideLiner beyond the tortuosity within the target vessel allowed delivery of the Rotablator burr enabling safe rotational atherectomy of the calcific lesion. In many cases due to the tortuosity of the vessel there is an increased risk of vessel perforation and difficulty in delivery of the RA burr to the site of the lesion. Rotational atherectomy (RA) which is usually accomplished with the Rotablator burr can facilitate lesion and stent expansion in highly calcific lesions. The GuideLiner is a rapid exchange “mother and child” guide extension catheter that allows deep and subselective intubation of the target vessel allowing for improved support during delivery of stents in highly tortuous vessels. We report a novel use of the GuideLiner for the delivery of an RA burr in tortuous vessels requiring increased guide support. The GuideLiner catheter, a child in mother catheter, has recently been used to allow for increased support for delivery of stents through tortuous vessels. In tortuous vessels it is often difficult to advance the burr without rotation and possible injury to the endothelium of healthy vessel. Rotational atherectomy (RA) for heavily calcified lesions is essential for improved stent delivery and stent expansion. ![]()
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