Theoretically, guide extension catheters such as GuideLiner (Teleflex) have a slightly bigger aspiration lumen however, with their distal-only collar, they require guidewire for navigation, which takes some of the extraction area.
Not only does it provide a much larger extraction lumen than conventional coronary aspiration catheters (approximately 70% bigger cross-sectional area), but being less rigid and more hydrophilic, it also offers much better trackability. It is extremely trackable, obviating even the use of a guidewire, with a wireless SNAKE technique (Sofia Non-wire Advancement techniKe) often used for its advancement in the cerebral circulation. The device we used in STEMI treatment is a 5 French, 125 cm Sofia catheter, with a soft, atraumatic tip and 17 cm long, hydrophilic, flexible distal segment ( Figures 2 A, B). Having tested several aspiration thrombectomy catheters in the tortuous intracranial vessels, we chose the 5 and 6 French Sofia (Microvention, Terumo) as one of our favorite intermediate catheters for ischemic stroke treatment. Building on our experience in stroke thrombectomy, we decided to reinvent neuroradiological devices for coronary interventions, much the same as the coronary armamentarium had inspired the invasive management of intracranial pathologies. There are only anecdotal reports of successful removal of a refractory clot with a stent retriever in the setting of acute myocardial infarction. Neurointerventional tools have not been routinely employed in coronary procedures. In all cases, successful aspiration with a Sofia catheter was performed without any procedural complications (e.g., dissection, distal embolization, stroke). We present four transradial procedures, in which a neurointerventional catheter was utilized to remove an otherwise unextractable or inaccessible clot. Their bigger lumen comes at a cost of worse trackability and a higher risk of artery dissection. Since standard monorail coronary aspiration devices are often ineffective in the case of a large thrombus, guide extension catheters have been used for clot extraction.
#GUIDELINER TELEFLEX MANUAL#
With a large thrombus being one of the strongest predictors of the no flow phenomenon, manual thromboaspiration remains an effective method of its prevention, especially in patients who cannot undergo a staged procedure after IIB/IIIA inhibitor administration because satisfactory reperfusion has not been achieved during the initial intervention. Despite inconclusive and conflicting results of trials and meta-analyses assessing aspiration thrombectomy in ST-segment elevation myocardial infarction (STEMI), trends toward reduced mortality were observed in the high thrombus burden subgroup.
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