Navigating the Uncrossable: Utilizing GuideLiner for Complex Coronary Lesions

Abstract

Background: Coronary calcification occurs when calcium accumulates in the plaque within the walls of the coronary arteries, serving as an early indicator of coronary artery disease. Managing calcified lesions is challenging, and various techniques can be employed, including cutting balloons, scoring balloons, high-pressure balloons, rotational atherectomy, orbital atherectomy, lithotripsy, and, notably, GuideLiner-assisted techniques.

Case Presentation: We present two cases involving calcified lesions that were successfully treated using the GuideLiner technique. The first case involves a 64-year-old male with a history of diabetes and hypertension who presented with non-ST elevation myocardial infarction (NSTEMI) and demonstrated normal left ventricular (LV) function. The second case features a 60-year-old male, also with a history of diabetes and hypertension, who presented with NSTEMI and moderate LV systolic dysfunction. In both instances, the GuideLiner technique played a crucial role in facilitating successful interventions for the complex calcified lesions.

Results: In both cases, while the lesions were easily crossed with semi-compliant and non-compliant balloons, stent delivery was initially unsuccessful. The use of the GuideLiner provided the necessary coaxial support to navigate the complex lesions, allowing for successful stent deployment. This approach not only facilitated the procedure but also enabled it to be performed via transradial access, avoiding the need for a shift to transfemoral access.

Conclusion: The GuideLiner technique proved to be an effective and safe method for the percutaneous treatment of complex coronary lesions when conventional angioplasty devices faced challenges. Its application, particularly in the transradial approach, enhances procedural success and minimizes fluoroscopy time, thereby reducing radiation exposure risks.