7/1/2023 0 Comments 6 fr guideliner![]() ![]() In conclusions, we would like to stress that in terms of 6 Fr guiding extensions, only the Guidezilla (Boston Scientific) shows good cooperation with the 1.25 mm burr and all 7 Fr work with both sizes. Unfortunately, none of the tested devices provide any space for the 1.75 mm burr, mainly due to the large diameter of the transparent sleeve. It seems that all 7 Fr devices cooperate with the 1.50 mm burr without any problems. The above-mentioned extensions that provide friction could be recommended only in bail-out situations or vessels that are not able to accept 7 Fr devices. The only extension which works with the 1.25 mm burr is the Guidezilla 6 Fr. One should note that aorta or large arterial vessel kinking may lead to the burr getting stuck. Of course, in in vivo circumstances, it could lead to problems with burr advancement. Two of the 6 Fr extensions (Guideliner and Guidon) are able to host the 1.25 mm burr but with perceptible friction. Theoretically, all extensions should be well fitted with a 1.25 mm burr, but in our tests two of them failed. Using commercially available extensions and two sizes of rotablation burr (1.25 and 1.50 mm) we found that there is a mismatch between producer declaration regarding inner size of the device and possibility of burr advancement deep into the extension. In our daily practice, we have faced this situation quite often, but several attempts during coronary angioplasty failed because of burr friction or getting stuck as well as mismatching of these two components. To our best knowledge, this is the first report comparing different guide catheter extensions with respect to feasibility of rotational atherectomy burr deliverability. The idea to use guiding catheter expansion to allow rotational atherectomy to be performed in a distal coronary lesion or increase guiding catheter support is not new. In this scenario, the operator should safely advance the burr as far as possible and start the rotablation at the closest point to the lesion. One knows that non-significant calcifications along the artery may affect the risk of the burr getting stuck if delivered during “dyna mode”. Of course, for many distal locations, it is too short to reach the lesion if the operator parks the burr just outside the guiding catheter. So far, the commercially available system for high speed rotational atherectomy has used a special advancer that allows one to perform a movement of about 7 cm. Limited technical features of rotational atherectomy were a significant hindrance to using it for this location. Calcified distal coronary lesion treated by coronary angioplasty remains a huge challenge for every interventional cardiologist. ![]()
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