Next-generation guide extension catheter delivers value during complex PCI
A new type of guide extension catheter (GEC) is associated with improved procedural efficiency and safety during complex percutaneous coronary intervention (PCI) procedures, according to new findings published in JSCAI.[1]
GECs have become integral to coronary interventions to provide extra support and assist in PCI device delivery. They are often used to overcome challenges such as difficult guide catheter engagement, a lack of guide catheter support and issues with vessel calcification or tortuosity. This has become increasingly important as radial vascular access continues to increase and additional support is often required.
These devices are also used to assist in deep coronary intubation, but the authors of the new study said this increases the risk of coronary dissection and is not always successful. They said first-generation GEC devices had limitations because they were blunt-ended tubular structures that carried a higher risk of dissection, caused damage to non-target lesion vessel segments and can even prolong the procedure time.
This study focused on early experiences with CrossFAST from Vantis Vascular in deep coronary intubation. This next-generation GEC was granted U.S. Food and Drug Administration clearance in December 2024. It uses a microcatheter-led device delivery system designed to deliver safe, deep coronary intubation. Researchers examind the use of the device in four different patients.
"The CrossFAST system was successfully used to deploy stents after failure of previously available equipment, including conventional GEC," wrote first author Michael Yang, MD, a cardiologist with Scripps Mercy Hospital in San Diego, and colleagues. "The edgeless transition, pushability, and the lack of need for balloon inflation and deflation allowed rapid delivery of the catheter to the target lesion beyond the calcified, tortuous segments, often to very distal portions of the arteries, while minimizing dissection risk."
Yang et al. said the first case overcame vessel friction and tortuosity issues to deliver a stent distally without the need for balloon-assisted tracking, even with a safe but nonsupportive guide. The fourth case, meanwhile, showed that even in very proximal left anterior descending (LAD) lesions, there can be obstructive disease from calcium or poorly deployed stents that can prevent conventional catheters from crossing.
"This is a nice illustration of the use of CrossFAST in an uncrossable proximal lesion, without the need for rotational atherectomy and its inherent risks. In addition, the speed of the sequential GEC system delivery, inner catheter removal, stent delivery, and outer catheter pullback was also paramount to limiting coronary ischemia and maximizing patient safety," the authors wrote.
The group concluded that this technology allows for the safe and rapid delivery of devices in the far reaches of coronary arteries.
Click here to read more in JSCAI, the flagship publication of the Society for Cardiovascular Angiography and Interventions.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]