Patients with borderline pre-procedural hemodynamics may not tolerate this technique. Third, as the double GuideLiner system may occlude blood flow, the patient must be carefully monitored for the development of ischemia and/or hemodynamic instability. Second, the operator must perform meticulous back-bleeding of the catheters to prevent air entrainment or thrombus embolization. First, injections through the system should generally be avoided to prevent hydraulic vessel dissection. Several steps by the operator can be utilized to prevent complications and achieve successful intervention with the double GuideLiner technique. In the presented cases no complications occurred. improved guide length to approach very distant targets i.e. delivery of stents through the GuideLiner with “unsheathing”, rather than risky “pushing” of equipment through severe tortuosities 2.

This novel technique offers two advantages: 1. This technique allows navigation of tortuous saphenous grafts to enable wiring of the retrograde limb of the native circulation. The presented cases are the first examples of utilization of a GuideLiner within a GuideLiner or the “mother-daughter-granddaughter” double GuideLiner technique. described over 300 cases of GuideLiner-facilitated PCI and showed an 80% procedural success rate.( 3) Additionally, the mother-daughter approach using the GuideLiner has been demonstrated to aid in CTO and SVG PCI.( 4) A recent retrospective study by Waterbury et al. GuideLiner-facilitated PCI is becoming increasingly common in clinical practice. We describe 2 cases of the “mother-daughter-granddaughter” double GuideLiner technique using a 6 Fr GuideLiner inside an 8 Fr GuideLiner to perform highly challenging PCI. The double bend of the anastomosis into the retrograde coronary artery combined with the antegrade turn of the target branch is often uncrossable even with modern balloon and stent technology. This is especially problematic when attempting percutaneous coronary intervention (PCI) on the retrograde limb of a bypassed coronary through a long saphenous vein graft (SVG). Minneapolis, Minnesota) is now commonly utilized to address these situations.( 1, 2) Despite the improved support provided by the GuideLiner catheter, occasions arise in which a single GuideLiner is not adequate to facilitate the delivery of stents or balloons to target lesions. The mother-daughter technique using a GuideLiner Catheter (Vascular Solutions, Inc.

Failure to deliver stents and balloons past tortuous, calcific lesions due to inadequate support has long plagued interventional cardiologists.

Guideliner 6f