Extra careful advancement of the stent is required for long stents. Long stents are less flexible and may not conform to the curves of the guide support extension catheter (GuideZilla) proximal port transition, which can contribute to similar sit- uations. One solution if the main vessel is tortuous, is to slightly withdraw the GuideZilla while advancing the stent forward, cautious to avoid ending the proximal GuideZilla collar on an angulated portion of the main vessel or aorta.

The stainless-steal collar embedded in the GuideZilla collar was designed for support and deliverability however, this may appear to work against stent advancement into the device when at acute angulations within main body vessels. The stainless-steel collar of the GuideZilla likely was not as flexible as an all-polymer collar of the GuideLiner as it was passed around the acute angulation of the aortic arch, causing the DES to catch the proximal edge of the transition of stainless steel collar, thus, impeding the stent delivery and permitting stent stripping as forward advancement was directed. This proximal junction seems to have been the nidus for the DES stripping in our case, particularly since this occurred in the steep angle of an ectatic aortic arch. One particular difference is the stainless-steal hypotube in the proximal shaft extending into a stainless-steel collar rather than a stainless-steel ribbon transition into an all-polymer material collar. The GuideZilla has a few different design features than the GuideLiner V2 (Fig. The hydrophilic coating on the outer diameter gives it a smooth finish that reduces friction (Fig. A polymer coats the stainless steel collar that is embedded in the proximal shaft to give more support and the stainless steel hypotube shaft provides support for push- ability, deliverability and kink resistance. 7 Its radiopaque safety tip is soft and flexible, designed to minimize the risk of vessel damage and complications. The design of the 1 Â 1 braided shaft gives the extra support but does not compromise flexibility and give-ability in the coronary ostium. It has a 1 Â 1 braid design to facilitate extra back-up support for complex or tortuous coronary anatomy without over-straightening the coronary arteries (Fig. 7 The GuideZilla has two radiopaque marker bands for visibility to facilitate accurate positioning in the aorto-ostium of coronary arteries (Fig. The 0.066 00 Outer-diameter reduces guide catheter interference. The inner-diameter allows more room to deliver interventional equipment, devices, and therapies. The GuideZilla guide support extension catheter has a 25 cm distal catheter segment which has 0.001 00 larger inner-diameter (0.057in, or 1.45 mm) and a 0.001 00 smaller outer-diameter (0.066in or 1.68 mm) compared to the GuideLiner V2 7 (Figs. Coronary equipment, including coronary balloons, stents, filter wires and some atherectomy devices can be advanced during complex or tortuous percutaneous coronary procedures. 7 The GuideZilla device is designed to make complex percutaneous coronary intervention (PCI) procedures easier by delivering interventional coronary equipment more efficiently.

The GuideZilla guide support extension catheter received Food and Drug Administration clearance in July 2013.

1 e 6 Our case highlights a potential complication associated with use of the GuideZilla catheter: dislodgement and stripping of the coronary stent from its delivery balloon upon introduction into the proximal GuideZilla edge. 1,2 Complications reported include coronary artery ischemia and dissection, stent damage on advancement or withdrawal into the GuideLiner, pressure dampening, balloon kinking or distal marker tip dislodgement. A similar device commercially available in the United States is the GuideLiner V2 (Vascular Solutions, Minneapolis, MN) which has rare, but reported, complications. Reported complications of the GuideZilla are limited in literature. angiography showed brisk TIMI-3 (Thrombolysis In Myocardial Infarction) antegrade flow with no residual dissection flap.

Guideliner