The GuideLiner ® : an interventionist ’ s experience of their first 50 cases : “ the mostly good , rarely bad , beware of the ugly ! ”

In the modern era of interventional cardiology, stent delivery failure in complex, tortuous and/or calcific coronary anatomy is encountered in approximately 5% of cases, leading to incomplete revascularization and procedural failure. The GuideLiner® catheter (Vascular Solutions, MN, USA) is a monorail guide catheter extension that facilitates safe and effective delivery of balloons and/or stents within challenging and complex coronary anatomy when conventional techniques have failed. It permits very deep intubation of the target vessel with coaxial alignment, thus providing effective backup support during the complex intervention. This article reports experiences with the GuideLiner in a series of 50 complex cases undertaken and/or supervised by one interventional cardiologist. We include a step-by-step description of the GuideLiner catheter delivery technique and effectively demonstrate its various clinical applications by way of illustrated case examples and practical ‘tips and tricks’ for optimal device performance. The GuideLiner catheter has undoubtedly expanded the complexity of cases that can be safely and effectively treated with percutaneous coronary intervention and, as such, is an essential tool utilized in contemporary percutaneous coronary intervention practice when conventional techniques are likely to fail.