Stent Damage Associated With a Guide Catheter Extension During Percutaneous Coronary Intervention

Keywords: complex PCI, guide catheter extension, percutaneous coronary intervention, stent

An 80-year-old woman with an acute coronary syndrome had severe stenosis in the mid-portion of left anterior descending (LAD) and subtotal occlusion just after a second diagonal (Figure 1A). Considering the lesion length and calcification and tortuosity of the LAD, we switched to a 7-Fr sheath. Using a 7-Fr EBU 3.5 guide catheter, the lesions were crossed with our standard workhorse wire and predilated. A priori use of a guide catheter extension (GCE) was decided to facilitate stent delivery, therefore, a 6-Fr Telescope GCE (Medtronic) was advanced in the mid LAD (Figure 1B). A 2.5 x 20-mm drug-eluting stent was then loaded on the guidewire and advanced forward. However, the operator felt high resistance and was unable to insert the stent into the distal cylinder of the Telescope. Assuming the stent was stuck at the level of the distal cylinder entry pot, we decided to remove both the GCE and the stent as a single unit to prevent complications. Stent distal edge appeared significantly damaged (Figure 1C). It is noteworthy that we finally managed to directly deliver and implant 3 drug-eluting stents with a very satisfactory angiographic result (Figure 1D).

Since the first GCE, the GuideLiner, was introduced in 2009, many other GCE systems have been developed and there is accumulating experience with their use. The Telescope GCE was launched in 2019 and was supposed to offer superior pushability and deliverability according to the manufacturer. To our knowledge, this is the first description of stent damage occurring during the insertion in the distal cylinder of the Telescope. Interventional cardiologists should always be prepared to face unexpected complications related to sophisticated devices such as GCE.

From the 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted June 1, 2022.

Address for correspondence: Dr Konstantinos C. Theodoropoulos, 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. Email: ktheod2005@hotmail.com