Deep intubation technique for Complex Percutaneous Coronary Intervention. Insights of a feared and harmless technique

Volume 5, Issue 2, April 2021     |     PP. 31-44      |     PDF (622 K)    |     Pub. Date: May 17, 2021
DOI: 10.54647/pmh33138    149 Downloads     5853 Views  

Author(s)

Ricardo Allende, Hospital de Especialidades Médicas de la Salud. San Luis Potosí, S.L.P. Mexico
Gérald Barbeau, Quebec Heart and Lung Institute. Quebec city, QC. Canada
Josep Rodés-Cabau, Quebec Heart and Lung Institute. Quebec city, QC. Canada

Abstract
Background: A successful percutaneous coronary intervention (PCI) on complex coronary anatomy can be up to 90% of cases and depends on many factors such as successfully guiding catheter support, which entails a perfect entry in the ostium of the treated artery, the guidewire´s ability to cross the culprit lesion and the stent profile. In some transradial artery cases the vessel´s diameter does not allow the use of a thick guiding catheter (from 6 to 8 Fr), in these cases special techniques such as “deep intubation” may be useful, if performed correctly.
Methods: We describe four different percutaneous coronary interventions (PCI) scenarios related to stent delivery in difficult procedures involving saphenous vein graft, mammary artery graft and native coronary arteries in complex anatomies with no incurring complications.
Results: Interestingly, deep-intubation has been considered a dangerous and contraindicated procedure to perform through coronary angioplasty, nonetheless we found that in many cases the deep intubation technique is an effective and convenient procedure when performed with small sized catheters at low cost.

Keywords
Deep intubation, complex angioplasty, transradial approach, percutaneous coronary intervention.

Cite this paper
Ricardo Allende, Gérald Barbeau, Josep Rodés-Cabau, Deep intubation technique for Complex Percutaneous Coronary Intervention. Insights of a feared and harmless technique , SCIREA Journal of Health. Volume 5, Issue 2, April 2021 | PP. 31-44. 10.54647/pmh33138

References

[ 1 ] Saeed B, Banerjee S, Brilakis ES. Percutaneous coronary intervention in tortuous coronary arteries: associated complications and strategies to improve success. J Interv Cardiol 2008;21:504-11.
[ 2 ] Jafary FH. When one won't do it, use two-double "buddy" wiring to facilitate stent advancement across a highly calcified artery. Catheter Cardiovasc Interv 2006;67:721-3.
[ 3 ] 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;59:482-8.
[ 4 ] Zhang S, Xu K, Yang N, Li C. Anchor balloons assisted deep intubation of 5F catheters for uncrossable lesions. Niger J Clin Pract 2016;19:421-5.
[ 5 ] Hashimoto S, Takahashi A, Yamada T, et al. Spontaneous rotation of the monorail-type guide extension support catheter during advancement of a curved guiding catheter: the potential hazard of twisting with the coronary guidewire. Cardiovasc Interv Ther 2018;33:379-83.
[ 6 ] Ashikaga T, Sakurai K, Satoh Y, et al. Mother-child technique using a novel 4 Fr inner catheter. EuroIntervention 2015;10:1432-9.
[ 7 ] 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;63:452-6.
[ 8 ] Kotowycz MA, Dzavik V. Radial artery patency after transradial catheterization. Circ Cardiovasc Interv 2012;5:127-33.
[ 9 ] Aznaouridis K, Bonou M, Masoura K, Vaina S, Vlachopoulos C, Tousoulis D. Successful Stent Delivery Through a Slaloming Coronary Path. J Invasive Cardiol 2019;31:E43.
[ 10 ] Bagur R, Gleeton O, Rinfret S, De Larochelliere R, Bertrand OF, Rodes-Cabau J. Transradial extra deep coronary intubation with a guide catheter for direct thromboaspiration in acute myocardial infarction. Int J Cardiol 2012;158:e32-4.
[ 11 ] Peels HO, van Boven AJ, den Heijer P, Tio RA, Lie KI, Crijns HJ. Deep seating of six French guiding catheters for delivery of new Palmaz-Schatz stents. Cathet Cardiovasc Diagn 1996;38:210-3.
[ 12 ] Bartorelli AL, Lavarra F, Trabattoni D, et al. Successful stent delivery with deep seating of 6 French guiding catheters in difficult coronary anatomy. Catheter Cardiovasc Interv 1999;48:279-84.
[ 13 ] Barlis P, Gonzalo N, Di Mario C, et al. A multicentre evaluation of the safety of intracoronary optical coherence tomography. EuroIntervention 2009;5:90-5.
[ 14 ] Garcia E, Moreno R, Gomez-Recio M. Successful stent delivery through 5 French guiding catheter. J Invasive Cardiol 2001;13:16-8.
[ 15 ] Di Mario C, Sutaria N. Coronary angiography in the angioplasty era: projections with a meaning. Heart 2005;91:968-76.
[ 16 ] Kumar S, Gorog DA, Secco GG, Di Mario C, Kukreja N. The GuideLiner "child" catheter for percutaneous coronary intervention - early clinical experience. J Invasive Cardiol 2010;22:495-8.
[ 17 ] de Man FH, Tandjung K, Hartmann M, et al. Usefulness and safety of the GuideLiner catheter to enhance intubation and support of guide catheters: insights from the Twente GuideLiner registry. EuroIntervention 2012;8:336-44.
[ 18 ] Nikolsky E, Gruberg L, Pechersky S, et al. Stent deployment failure: reasons, implications, and short- and long-term outcomes. Catheter Cardiovasc Interv 2003;59:324-8.
[ 19 ] Latsios G, Toutouzas K, Karanasos A, Tousoulis D. Use of Extra Deep Guide-Catheter Intubation for Rotablation-Facilitated Percutaneous Coronary Intervention of the Right Coronary Artery. Cardiovasc Revasc Med 2019;20:13-4.
[ 20 ] Moretti A, Sanz Sanchez J, Petriello G, Gasparini GL. Ultra-Deep Guide Catheter Intubation for Direct Thromboaspiration in Acute Myocardial Infarction. Cardiovasc Revasc Med 2019;20:49-50.
[ 21 ] Di Mario C, Ramasami N. Techniques to enhance guide catheter support. Catheter Cardiovasc Interv 2008;72:505-12.
[ 22 ] Von Sohsten R, Oz R, Marone G, McCormick DJ. Deep Intubation of 6 French Guiding Catheters for Transradial Coronary Interventions. J Invasive Cardiol 1998;10:198-202.
[ 23 ] Mamas MA, Eichhofer J, Hendry C, et al. Use of the Heartrail II catheter as a distal stent delivery device; an extended case series. EuroIntervention 2009;5:265-71.
[ 24 ] Zanchetta M, Pedon L, Rigatelli G, Olivari Z, Zennaro M, Maiolino P. Pseudo-lesion of internal mammary artery graft and left anterior descending artery during percutaneous transluminal angioplasty--a case report. Angiology 2004;55:459-62.
[ 25 ] Wong P, Rubenstein M, Inglessis I, Pomerantsev E, Ferrell M, Leinbach R. Spontaneous spiral dissection of a LIMA-LAD bypass graft: a case report. J Interv Cardiol 2004;17:211-3.
[ 26 ] Cantor WJ, Lazzam C, Cohen EA, et al. Failed coronary stent deployment. Am Heart J 1998;136:1088-95.
[ 27 ] Mamas MA, Fath-Ordoubadi F, Fraser DG. Telescoping catheter technique: looking towards the kidneys. Cardiovasc Revasc Med 2011;12:123-8.
[ 28 ] 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;78:847-63.
[ 29 ] 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;80:437-46.
[ 30 ] D'Amario D, Galli M, Vergallo R, Crea F, Porto I. How deep is your lesion? Extreme guideliner V3 intubation through RIMA graft to treat a distal left anterior descending artery stenosis. J Cardiovasc Med (Hagerstown) 2018;19:606-8.
[ 31 ] Park CI, Noble S, Bonvini RF. Guideliner microcatheter to improve back-up support during a complex coronary stenting procedure through a tortuous left internal mammary graft. J Invasive Cardiol 2012;24:E77-9.
[ 32 ] Cho SY, Moon KW, Kim JH, et al. The "Five-in-Seven" Guiding Technique to Overcome Proximal Coronary Tortuosity During Primary Percutaneous Coronary Intervention. Korean Circ J 2010;40:421-2.