title: Enhancing back-up support during difficult coronary stent delivery: single-center case series of experience with the Heartrail II catheter.
abstract: BACKGROUND
  Despite continued advances in creating lower-profile intracoronary balloons and stents, technical difficulties with stent deliverability are frequently encountered. Recent advances in catheter design have yielded soft ended atraumatic catheters for use within standard guide catheters - the so called double coaxial guiding catheter technique. We report our preliminary experience using the 5 Fr Terumo guide catheter (Heartrail II, Terumo) from a single center.
  
  
  METHODS
  We describe six percutaneous coronary intervention (PCI) procedures where stent deployment initially failed during the standard approach. Subsequent utilization of this 5 Fr catheter system within a standard 6 Fr guide facilitated successful procedural outcomes. This catheter system facilitated non-traumatic deep intubation and stent delivery beyond the site of obstruction encountered during PCI of the distal right coronary and left anterior descending arteries.
  
  
  RESULTS
  3 males and 3 females with a mean age of 72.5 ± 5.4 years underwent PCI using the Heartrail II catheter. Patient and procedural characteristics are summarized in Table 1. The intracoronary catheter was inserted into 3 right coronary arteries, 2 left circumflex arteries and 1 left anterior descending artery. Classification of discrete lesions yielded 6 type C lesions. The mean number of stents deployed was 3.33 ± 0.80 with a mean procedure X-ray screening duration of 35.04 ± 7.79 minutes. No complications relating to ostial artery catheter-induced dissections were encountered.
authors.affiliation: Vascular Medicine and Intervention, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA. bghynes@hotmail.com
authors.forename: Brian
authors.initials: B
authors.lastname: Hynes
authors.forename: James
authors.initials: J
authors.lastname: Dollard
authors.forename: Grainne
authors.initials: G
authors.lastname: Murphy
authors.forename: John
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ruggiero
authors.forename: Ronan
authors.initials: R
authors.lastname: Margey
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kiernan
authors.forename: Eugene
authors.initials: E
authors.lastname: McFadden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D057785:Catheters; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents