GUIDEZILLA™ II
Guide Extension Catheter
Patient History
- Originally presented in a NSTEMI situation
- Intervention on RCA and Circumflex performed at that time
- Follow up appointment for elective PCI of the LAD and first Diagonal (D1)
Diagnostic Angiogram
- Previous stents placed in the RCA and Circumflex are widely patent
- Disease in LAD and D1 unchanged from previous angiogram
- Severe vessel overlay and difficulty understanding healthy to healthy
landing zones (Figure 1)
Figure 1
Anticipated Challenges
Figure 2
- The physician recognized the severity of the disease and the challenges of delivering interventional devices
- The decision was made prior to the case to utilize the GUIDEZILLA™ II Guide Extension Catheter for support in delivering various devices
Procedure
- Due to severe overlay, a selective angiogram utilizing the GUIDEZILLA II Guide Extension Catheter (Figure 2) was performed and demonstrated a > 70% lesion in both the LAD and ostium of D1
- Pre-dilatation of the diagonal was performed with a PTCA balloon catheter
- Subsequently, a stent was delivered, landing the proximal aspect in the LAD
- Proximal Optimization Technique (POT) was performed in the ostium of D1 and proximal LAD with semi- and non-compliant balloons, respectively
- The SAMURAI™ Guidewire was retracted from D1 and advanced to the distal LAD through the previously placed stent, ensuring luminal access
- Difficulty introducing a winged balloon was experienced and the GUIDEZILLA II Catheter was reintroduced for support
- Successful crossing of the stent struts was obtained and the semi‑compliant balloon was inflated
- Once the balloon was deflated, the GUIDEZILLA II Catheter was advanced across the stent struts through the utilization of the “Inchworm”* technique, allowing easier delivery of a stent (Figure 3)
- Delivery and inflation of a stent was successful, landing proximally to the previously deployed D1 stent
- Rewiring of D1 with a second SAMURAI™ Guidewire was performed
- Delivering a balloon through the stent struts proved difficult, so the GUIDEZILLA™ II Catheter was utilized for additional support
- Diffuse disease on the initial angiogram was acknowledged by the physician and the decision was made to place a stent from the proximal LAD into the Left Main
- The GUIDEZILLA II Catheter was used to help facilitate delivery of this stent with the Left Main and LAD portions of the stent post dilated with an NC Balloon
- To check for optimal stent placement, IVUS was advanced down the LAD
- The physician acknowledged there were no distal stent edge dissections, excellent stent apposition, full stent expansion, and excellent integrity of the neocorina made at the LAD/D1 bifurcation (Figure 4)
- The final angiogram demonstrated a widely patent left coronary system (Figure 5)
Figure 3
Figure 4
Figure 5
