Most of these obstacles can be dealt with by certain tips and tricks including use of GCES. In the current era of trans-radial interventions, the main reasons of procedural failure include arterial spasms, failure to puncture access site, failure to cannulate the lesion vessel, lack of adequate guide support, and inability to use guide catheters larger than 7F. 1, 2, 3, 4 With as little as 5 mm of extension, bench testing has shown that the GCES significantly increases back-up support of a standard 6F guide catheter and provides superior deliverability. GCES has been utilized in both femoral and radial approaches for native coronary, graft, and peripheral interventions with success rates above 90%. GCES provides coaxial guide extension over monorail support. Guide catheter extension system (GCES) increases guide back-up support and is crucial in complex PCI procedures, particularly in cases of severe calcification and tortuosity. Various techniques to increase guide support include passive techniques (larger guide dimensions and switching to Amplatzer left (AL) over Judkins) and active techniques (deep intubation of same guide, use of balloon/microcatheter, and guide catheter extension). To overcome the aforementioned obstacles, many strategies such as improved lesion preparation, increased use of stiffer guidewires, buddy wire technique, and increased guide support have been employed over the years. The main factors which lead to failure of equipment delivery include poor back-up force, poor axial alignment (increased friction between rigid stent and vessel wall), and increased tortuosity of the target vessel. Among many causes of procedural failure, failure to deliver equipment (stent/balloon/thrombosuction device/rotablation catheter/coils etc.) is frequent. Percutaneous coronary intervention (PCI) is an established technique for management of coronary artery disease (CAD) which includes both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).This procedure is continuously and rapidly evolving and is often preferred over coronary artery bypass grafting (CABG), even in complex anatomy.
0 kommentar(er)
