1. The First Affiliated Hospital of Harbin Medical University
How to improve stent
Deliverbility ?
Li Yue, M.D.
The First Affiliated Hospital of Harbin Medical University

2. Challenges for stent delivery
Severe calcification
Proximal vessel tortuosity
Sharply angulated segments
Diffuse disease
Angiography was performed Through the radial approach using a tiger catheter.

3. Tips and tricks for stent delivery
Guiding catheter
Increase size / extra-support shape
Deep seated
Inner catheter
Wire & balloon
Stiffer wire
Buddy wire / balloon
Anchor wire / balloon
Plaque modification
Rota / cutting balloon
Stent
Shorter / flexible / small profile(BMS)
Angiography was performed Through the radial approach using a tiger catheter.

4. Inner catheter 5 in 6 guiding catheter technique
Heartrail II (Terumo, Japan)
long (120 cm) 5 Fr catheter
Absence of curve and the flexibility of its tip permit the
“child” catheter coaxial with the target vessel, minimizing
the risk of dissection.
Angiography was performed Through the radial approach using a tiger catheter.

5. Coronary artery injury
Angiography was performed Through the radial approach using a tiger catheter.
Coronary artery injury
Deep-vessel engagement can be facilitated by passage of a balloon catheter
Air embolism

6. Angiography was performed Through the radial approach using a tiger catheter.
7F AL-1; 3.5mm balloon

7. Angiography was performed Through the radial approach using a tiger catheter.

8. (Goodman, Japan)
Angiography was performed Through the radial approach using a tiger catheter.

9. Angiography was performed Through the radial approach using a tiger catheter.
The lumen size of the aspiration catheter as the size of SES is limited to 3.0 mm.

10. GuideLiner cath Rapid exchange
Flexible yellow 20 cm straight extension connected to
a stainless-steel push tube
Results in an I.D. approximately 1F size smaller
available in three sizes: 6F, 7F and 8F
Angiography was performed Through the radial approach using a tiger catheter.

11. Angiography was performed Through the radial approach using a tiger catheter.

12. Angiography was performed Through the radial approach using a tiger catheter.

13. Angiography was performed Through the radial approach using a tiger catheter.

14. Not recommend its use in target vessels of < 2.5 mm diameter
Angiography was performed Through the radial approach using a tiger catheter.
Not recommend its use in target vessels of < 2.5 mm diameter

15. Softer tip and hydrophilic coating on inside and outside.
5-Fr ST01 has the coating only on the inside.
Angiography was performed Through the radial approach using a tiger catheter.
(Terumo, Japan)
Catheterization and Cardiovascular Interventions 76:919–923 (2010)

16. KIWAMI ST01
Angiography was performed Through the radial approach using a tiger catheter.

17. Peripheral balloon anchor method
Balloon used for predilatation to the most distal portion of the lesion.
Inflated and used as the anchor
KIWAMI is inserted slowly toward inflated anchoring balloon.
Not to dilate the balloon at the healthy portion
Angiography was performed Through the radial approach using a tiger catheter.

18. Angiography was performed Through the radial approach using a tiger catheter.
Cypher (3.0 × 18 mm)

19. 5-Fr ST01 allows any BMS and DES
KIWAMI effective for stents with a diameter up to 3.0 mm for Cypher and TAXUS Liberte, 3.5 mm for Endeavor
Most of BMS can be deployed using KIWAMI except DRIVER (Medtronic)
Angiography was performed Through the radial approach using a tiger catheter.

20. Tips and tricks for stent delivery
Guiding catheter
Increase size / extra-support shape
Deep seated
Inner catheter
Wire & balloon
Stiffer wire
Buddy wire / balloon
Anchor wire / balloon
Plaque modification
Rota / cutting balloon
Stent
Shorter / flexible / small profile(BMS)
Angiography was performed Through the radial approach using a tiger catheter.

21. Buddy Wire & Buddy Balloon
Provide the guiding catheter stability
Straighten the tortuous segment of the artery
Deflect the stent delivery system away from
the calcified area
Angiography was performed Through the radial approach using a tiger catheter.

22. Buddy Balloon
Angiography was performed Through the radial approach using a tiger catheter.

23. Inflated Buddy Balloon
LMS / ostial LCX
Predilated
2.5 X 15 mm balloon
3.5 X 10 mm cutting balloon
LAD
1.25, 1.5 bur
Angiography was performed Through the radial approach using a tiger catheter.

24. 4.5 X 32 mm Liberty could cross 3.5 X 20 mm balloon Buddy wire
Buddy balloon (3.5 X 20 mm)
Inflation of the buddy balloon to 2 atm, the distal stent edge was deflected enough from the plaque to allow its passage
Angiography was performed Through the radial approach using a tiger catheter.

25. Angiography was performed Through the radial approach using a tiger catheter.

26. Angiography was performed Through the radial approach using a tiger catheter.

27. 3.0/14-mm balloon was placed at the lesion, SES was
placed at the proximal lesion.
Just after balloon deflation, SES was delivered to the
lesion easily.
Angiography was performed Through the radial approach using a tiger catheter.

28. Angiography was performed Through the radial approach using a tiger catheter.

29. Tips and tricks for stent delivery
Guiding catheter
Increase size / extra-support shape
Deep seated
Inner catheter
Wire & balloon
Stiffer wire
Buddy wire / balloon
Anchor wire / balloon
Plaque modification
Rota / cutting balloon
Stent
Shorter / flexible / small profile
Angiography was performed Through the radial approach using a tiger catheter.

30. Anchor wire
Angiography was performed Through the radial approach using a tiger catheter.

31. Stent delivery still impossible
Angiography was performed Through the radial approach using a tiger catheter.
1.25, 1.5 mm bur
3.0 X 15 mm predalation
Stent delivery still impossible

32. Then a 3.5 x 18 mm Xience V was advanced to distal RCA.
Angiography was performed Through the radial approach using a tiger catheter.
Deployment of a 3.5 x 23 mm Xience V in the proximal-mid RCA jailing the support buddy wire.
Then a 3.5 x 18 mm Xience V was advanced to distal RCA.

33. Angiography was performed Through the radial approach using a tiger catheter.

34. Anchor balloon Anchor in side branch Anchor in same artery
Angiography was performed Through the radial approach using a tiger catheter.
Anchor in side branch
Anchor in same artery

35. Angiography was performed Through the radial approach using a tiger catheter.

36. Angiography was performed Through the radial approach using a tiger catheter.

37. Super anchor balloon
Angiography was performed Through the radial approach using a tiger catheter.

38. Tips and tricks for stent delivery
Guiding catheter
Increase size / extra-support shape
Deep seated
Inner catheter
Wire & balloon
Stiffer wire
Buddy wire / balloon
Anchor wire / balloon
Plaque modification
Rota / cutting balloon
Stent
Shorter / flexible / small profile(BMS)
Angiography was performed Through the radial approach using a tiger catheter.

39. Angiography was performed Through the radial approach using a tiger catheter.

40. Tips and tricks for stent delivery
Guiding catheter
Increase size / extra-support shape
Deep seated
Inner catheter
Wire & balloon
Stiffer wire
Buddy wire / balloon
Anchor wire / balloon
Plaque modification
Rota / cutting balloon
Stent
Shorter / flexible / small profile(BMS)
Angiography was performed Through the radial approach using a tiger catheter.

41. Antegrade PCI used a Fielder and Miracle 3 wire unsuccessful
Antegrade PCI used a Fielder and Miracle 3 wire unsuccessful. A large dissection in the RV branch.

42. A Fielder wire was advanced into the aorta retrogradely.
The retrograde balloon (Voyager mm) inflated in RCA.
Multiple attempts to pass a guidewire antegradely were unsuccessful.

43. Retrogradely passed a 2.5- 8 mm Mini-Vision stent to the RCA ostium.
Subsequently, 5 more Vision stents (2.5-12, , , and ).

44. Because the patient had previously undergone CABG with the risk of perforation from epicardial collateral passage consequently decreased.

51. Thanks !