Techniques to Overcome Difficulty in Device Deliverability to Lesion in Complex PCI

Author(s): Raman Chawla*, Wasim Ahamad, Vivek Sharma

Journal Name: Current Cardiology Reviews

Volume 16 , Issue 2 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Percutaneous Coronary Intervention (PCI) has revolutionized the management of Coronary Artery Disease and has become the preferred modality of revascularization in a majority of cases. Nevertheless, situations are encountered frequently where device deliverability to coronary lesions entails technical difficulties due to varied anatomies and lesional complexities like tortuosity, calcifications, length of lesions and vessel morphology. While continuous technological refinements are occurring in PCI hardware armamentarium and stent designs, a number of techniques and their modifications and variations have evolved to increase the applicability of PCI to difficult lesions.

The present article envisages a thorough review of all aspects of improving successful device deliverability in complex PCI with prominent emphasis on increasing the backup support of Guide Catheters which is the primary factor of success in difficult coronary lesions.

Keywords: Percutaneous Coronary Intervention (PCI), Drug-Eluting Stents (DES), Chronic Total Occlusion (CTO), Transradial Interventions (TRI), mother- child technique, guideliner, buddy wire, anchor balloon.

Hynes B, Dollard J, Murphy G, et al. Enhancing back-up support during difficult coronary stent delivery: single-center case series of experience with the Heartrail II catheter. J Invasive Cardiol 2011; 23(3): E43-6.
[PMID: 21364247]
Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol 1995; 25(4): 855-65.
[] [PMID: 7884088]
Jolly SS, Yusuf S, Cairns J, et al. RIVAL trial group. Radial vs. femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011; 377(9775): 1409-20.
[] [PMID: 21470671]
Ali R, Greenbaum AB, Kugelmass AD. A review of available angioplasty guiding catheters, wires and balloons - making the right choice. Interv Cardiol (Lond) 2012; 7(2): 100-3.
Burzotta F, Trani C, Mazzari MA, et al. Use of a second buddy wire during percutaneous coronary interventions: a simple solution for some challenging situations. J Invasive Cardiol 2005; 17(3): 171-4.
[PMID: 15867450]
Meerkin D. My buddy, my friend: focused force angioplasty using the buddy wire technique in an inadequately expanded stent. Catheter Cardiovasc Interv 2005; 65(4): 513-5.
[] [PMID: 15900556]
Fujita S, Tamai H, Kyo E, et al. New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: the anchor technique. Catheter Cardiovasc Interv 2003; 59(4): 482-8.
[] [PMID: 12891613]
Mahmood A, Banerjee S, Brilakis ES. Applications of the distal anchoring technique in coronary and peripheral interventions. J Invasive Cardiol 2011; 23(7): 291-4.
[PMID: 21725125]
Pervaiz MH, Laham RJ. Distal anchoring technique: yet another weapon for successful intervention. J Invasive Cardiol 2011; 23(7): 295-6.
Hirokami M, Saito S, Muto H. Anchoring technique to improve guiding catheter support in coronary angioplasty of chronic total occlusions. Catheter Cardiovasc Interv 2006; 67(3): 366-71.
[] [PMID: 16475189]
Pancholy SB. Enhancing guide support during a complex coronary intervention via transradial Approach. 2014; 22(6)
Shamoon FE, Younan SK, Chakhtoura EY. “Buddy wire” technique to overcome proximal coronary tortuosity during rotational atherectomy. J Invasive Cardiol 2005; 17(11): E30-2.
[PMID: 16264213]
Newton CM, Lewis SA, Vetrovec GW. Technique for guiding catheter exchange during coronary angioplasty while maintaining guidewire access across a coronary stenosis. Cathet Cardiovasc Diagn 1988; 15(3): 173-5.
[] [PMID: 2973839]
Takahashi S, Saito S, Tanaka S, et al. New method to increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv 2004; 63(4): 452-6.
[] [PMID: 15558766]
Tobita K, Takeshita S, Saito S. The 4-in-5 mother-child technique: 5 Fr transradial coronary intervention for complex lesions using a 4 Fr child catheter. J Invasive Cardiol 2013; 25(8): 406-8.
[PMID: 23913606]
Takeshita S, Takagi A, Saito S. Backup support of the mother-child technique: technical considerations for the size of the mother guiding catheter. Catheter Cardiovasc Interv 2012; 80(2): 292-7.
[] [PMID: 22234930]
Takeshita S, Shishido K, Sugitatsu K, et al. In vitro and human studies of a 4F double-coaxial technique (“mother-child” configuration) to facilitate stent implantation in resistant coronary vessels. Circ Cardiovasc Interv 2011; 4(2): 155-61.
[] [PMID: 21364150]
Farooq V, Mamas MA, Fath-Ordoubadi F, Fraser DG. The use of a guide catheter extension system as an aid during transradial percutaneous coronary intervention of coronary artery bypass grafts. Catheter Cardiovasc Interv 2011; 78(6): 847-63.
[] [PMID: 21234926]
Dardas PS, Mezilis N, Ninios V, Tsikaderis D. The use of the GuideLiner™ catheter as a child-in-mother technique: an initial single-center experience. Heart Vessels 2012; 27(5): 535-40.
[] [PMID: 21866347]
Kasturi S, Vilvanathan VK, Bandimida SK, et al. Usefulness of guideliner catheter during percutaneous coronary intervention in difficult to cross complex lesions due to calcification and tortuosity. J Cardiol Ther 2014; 2: 96-104.
Zhang Q, Zhang RY, Kirtane AJ, et al. The utility of a 5-in-6 double catheter technique in treating complex coronary lesions via transradial approach: the DOCA-TRI study. EuroIntervention 2012; 8(7): 848-54.
[] [PMID: 23171804]
Furini FR, Oliveira AT, Francisco RSB, et al. ‘Mother and Child’ technique with a new catheter: Initial experience. Rev Bras Cardiol Invasiva 2012; 20(2): 208-12.
Hachinohe D, Saito S, Tani T, Yamazaki S. Mother-and-child technique using 4-Fr inner catheter for stent delivery during provisional stenting. Cardiovasc Interv Ther 2012; 27(2): 105-9.
[] [PMID: 22623004]
Uchida Y, Nakashima H, Takeshita S. Modified mother-child technique using a buddy wire. J Invasive Cardiol 2014; 26(5): E52-3.
[PMID: 24791725]
Papayannis AC, Michael TT, Brilakis ES. Challenges associated with use of the GuideLiner catheter in percutaneous coronary interventions. J Invasive Cardiol 2012; 24(7): 370-1.
[PMID: 22781481]
Chen Y, Fang CC, Yu CL, Jao YT, Wang SP. Intracoronary retrieval of the dehisced radiopaque ring of a guiding catheter: an unusual complication of coronary angioplasty. Catheter Cardiovasc Interv 2002; 55(2): 262-4.
[] [PMID: 11835663]
Luna M, Papayannis A, Holper EM, Banerjee S, Brilakis ES. Transfemoral use of the GuideLiner catheter in complex coronary and bypass graft interventions. Catheter Cardiovasc Interv 2012; 80(3): 437-46.
[] [PMID: 21805572]
Erglis A, Narbute I, Strenge K, Jegere S. Importance of plaque modification before coronary artery stenting. ENJ Int Cardiol 2013; 1(1): 64-9.
Joyal D, Thompson CA, Grantham JA, Buller CE, Rinfret S. The retrograde technique for recanalization of chronic total occlusions: a step-by-step approach. JACC Cardiovasc Interv 2012; 5(1): 1-11.
[] [PMID: 22230144]
Hamood H, Makhoul N, Grenadir E, Kusniec F, Rosenschein U. Anchor wire technique improves device deliverability during PCI of CTOs and other complex subsets. Acute Card Care 2006; 8(3): 139-42.
[] [PMID: 17012127]
van der Sijde JN, Karanasos A, van Ditzhuijzen NS, et al. Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound. Eur Heart J Cardiovasc Imaging 2017; 18(4): 467-74.
[PMID: 26992420]
Bezerra HG. Intravascular OCT in PCI.. June 13, 2016 Available here Accessed August 6, 2018.
Koganti Sudheer, et al. Choice of intracoronary imaging: When to use intravascular ultrasound or optical coherence tomography. Interven Cardiol (London, England) 2016; 11(1): 11-6.
Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA. Outcomes with intravascular ultrasound-guided stent implantation: A meta-analysis of randomized trials in the era of drug-eluting stents. Circ Cardiovasc Interv 2016; 9(4): e003700
[] [PMID: 26980883]
Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American college of cardiology foundation/american heart association task force on practice guidelines and the Society for cardiovascular angiography and interventions. Circulation 2011; 124(23): e574-651.
[] [PMID: 22064601]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [117 - 124]
Pages: 8
DOI: 10.2174/1573403X15666191018105627
Price: $65

Article Metrics

PDF: 19