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Guide Extension Catheter

Case Study: Utilization of GUIDEZILLA II Guide Extension Catheter in Complex Disease

Key Learning Points

  • GUIDEZILLA II Guide Extension Catheter is an excellent supportive device for delivery of interventional devices
  • There are multiple uses and delivery options for GUIDEZILLA II Guide Extension Catheter
  • IVUS optimization is critical for best patient outcomes
  • ”The “Inchworm” technique involves advancing the GUIDEZILLA II Extension Catheter over a recently deflated balloon for further advancement down the artery

Patient History

  • Originally presented in a NSTEMI situation
  • Intervention on RCA and Circumflex performed at that time
  • Follow up appointment for elective PCI of the LAD and first Diagonal (D1)

Diagnostic Angiogram

  • Previous stents placed in the RCA and Circumflex are widely patent
  • Disease in LAD and D1 unchanged from previous angiogram
  • Severe vessel overlay and difficulty understanding healthy to healthy
    landing zones (Figure 1)

Figure 1

Anticipated Challenges

Figure 2

  • The physician recognized the severity of the disease and the challenges of delivering interventional devices
  • The decision was made prior to the case to utilize the GUIDEZILLA™ II Guide Extension Catheter for support in delivering various devices


  • Due to severe overlay, a selective angiogram utilizing the GUIDEZILLA II Guide Extension Catheter (Figure 2) was performed and demonstrated a > 70% lesion in both the LAD and ostium of D1
  • Pre-dilatation of the diagonal was performed with a PTCA balloon catheter
  • Subsequently, a stent was delivered, landing the proximal aspect in the LAD
  • Proximal Optimization Technique (POT) was performed in the ostium of D1 and proximal LAD with semi- and non-compliant balloons, respectively
  • The SAMURAI™ Guidewire was retracted from D1 and advanced to the distal LAD through the previously placed stent, ensuring luminal access
  • Difficulty introducing a winged balloon was experienced and the GUIDEZILLA II Catheter was reintroduced for support
  • Successful crossing of the stent struts was obtained and the semi‑compliant balloon was inflated
  • Once the balloon was deflated, the GUIDEZILLA II Catheter was advanced across the stent struts through the utilization of the “Inchworm”* technique, allowing easier delivery of a stent (Figure 3)
  • Delivery and inflation of a stent was successful, landing proximally to the previously deployed D1 stent
  • Rewiring of D1 with a second SAMURAI™ Guidewire was performed
  • Delivering a balloon through the stent struts proved difficult, so the GUIDEZILLA™ II Catheter was utilized for additional support
  • Diffuse disease on the initial angiogram was acknowledged by the physician and the decision was made to place a stent from the proximal LAD into the Left Main
  • The GUIDEZILLA II Catheter was used to help facilitate delivery of this stent with the Left Main and LAD portions of the stent post dilated with an NC Balloon
  • To check for optimal stent placement, IVUS was advanced down the LAD
  • The physician acknowledged there were no distal stent edge dissections, excellent stent apposition, full stent expansion, and excellent integrity of the neocorina made at the LAD/D1 bifurcation (Figure 4)
  • The final angiogram demonstrated a widely patent left coronary system (Figure 5)

Figure 3

Figure 4

Figure 5