Telescoping catheter technique in percutaneous coronary intervention. How would I approach it?

HOW WOULD I APPROACH IT?

The authors present an interesting and challenging case regarding percutaneous treatment, and with a very complex resolution. This is the case of a patient already surgically revascularized with significant ischemia whose revascularization option is through the bypass on which the entire territory of the left circumflex artery depends on.

At this point right now of the angioplasty where the stent cannot be crossed despite the use of the buddy-wire technique, and even though the stent was very short and had good navigability, I would try the following staged maneuvers:

Figure 1. Example of anchorage inflating a balloon in the artery distal area and slightly pulling the hypotube back out to gently advance the guide extension catheter (in yellow).

Figure 2. The guide extension catheter is advanced towards the lesion more proximal site, and the artery is deeply intubated, which increases support.

Although it is true that this deep intubation technique is widely used in native coronary arteries and was described some time ago,1,2 it should be used with extra care when dealing with bypasses, especially in the saphenous vein, to avoid dissecting or even perforating the saphenous vein bypasses that often appear degraded.

In this case the fact that the emergency of the saphenous vein bypass does not have a great proximal tortuosity and is properly aligned with the guide catheter used was an advantage.

Also, the type of guide extension catheter used should be carefully selected because there are many different ones available in the market. Some provide strength to give great support while others provide flexibility for deeper intubation without too much damage to the arteries.

FUNDING

None whatsoever.

CONFLICTS OF INTEREST

None reported.

REFERENCES