Transradial interventions with the GuideLiner catheter: Role of proximal vessel angulation

Background: Transradial coronary intervention (TRI) is increasingly common, but anatomic variations and lack of guide catheter support may increase the complexity of TRI. The GuideLiner catheter (Vascular Solutions, Minneapolis, MN) is a guide catheter extension developed to provide increased guide catheter support. We hypothesized that TRI cases requiring GuideLiner support would have a greater proximal vessel angle and increased lesion angle tortuosity. Methods: This was a retrospective study reviewing 146 TRI cases performed at a single institution between August 2010 and June 2012. 22 cases (15%) required use of the GuideLiner support catheter. Procedural and angiographic characteristics of all cases were analyzed. Multivariable analysis and receiver operator curves (ROC) were used to analyze predictors of GuideLiner use. Results: The indications for TRI were similar between both groups. Subjects who required use of the GuideLiner support catheter at the time of TRI were significantly older (69 +/- 12 years vs. 62 +/- 13 years, p = 0.03). The proximal vessel angle was significantly greater in the cases requiring GuideLiner support (74 degrees +/- 35 vs. 37 degrees +/- 23 degrees, p < 0.001). Lesion angle in the Guideliner group was also significantly greater (48 degrees +/- 32 degrees vs. 28 degrees +/- 25 degrees, p < 0.001). On multivariable analysis, proximal vessel angle independently predicted the need for GuideLiner support (AOR 1.4 per 10 degrees, p b 0.001). A 45 degrees proximal vessel angle predicted the need for GuideLiner use with a sensitivity of 73% and specificity of 74% (c-statistic 0.79). None of the Guideliner TRI cases required conversion to femoral access. Conclusions: TRIs requiring GuideLiner catheter support had significantly increased lesion complexity and vessel tortuosity. Proximal vessel angulation is significantly associated with the need for GuideLiner use during transradial intervention. Use of the Guideliner facilitated successful completion of PCI despite the use of a wide variety of guiding catheters in this series. (C) 2013 Elsevier Inc. All rights reserved.