Use of “motherandchild” catheter in complex percutaneous coronary intervention

AIM:To probe the safety and efficacy of “mother and child” catheter in such complex percutaneous coronary intervention as chronic total occlusions (CTO) and serious torturous and diffuse calcified lesions. METHODS: Heartrail “mother and child” catheter (or five in six catheter) system (Terumo, Japan) involves insertion of a flexible tipped extralength 120cm 5 Fr guiding catheter through a standard 100cm 6 Fr guide catheter so that its tip extends into the vessel allowing extra deep intubation; hence, increasing backup support. In this study, the hemostatic valve was disconnected from the guide catheter and the Heartrail device was passed through the guide catheter into the target vessel either over a coronary wire or a wire and a balloon catheter with the balloon uninflated in the distal vessel. The hemostatic valve was then reattached to the end of the Heartrail catheter and the interventional procedure was performed in the usual manner through the hemostatic valve. Intubation depth was decided by the backup force needed. RESULTS: A total of 26 complex coronary lesions, which failed to cross by guide wire, balloon catheter or stent with routine methods from June, 2008 to December, 2010 were selected for the treatment with Heartrail child catheters. The lesions included five LAD (19%), six LCX (23%) and 15 RCA (58%). Among these lesions, six (23%) were CTO, 15 (58%) associated with serious torturous vessels, 10(38%) associated with proximal stent, and 15(58%) associated with serious calcification. Success was achieved in 24(92%) lesions with stent implanted and failure in two lesions which, in both, the balloon failed to cross. Air embolism was found in two lesions with normal blood flow after artery blood injection. No arterial perforation and dissection was found during the procedure. No deaths or reinfarction occurred during the 3month followup. CONCLUSION: The results indicate that “mother and child” catheter system is safe and efficient and could increase backup support and help implant distal stent when routine methods fail in complex percutaneous coronary intervention. Precautions, however, should be taken to prevent air embolism during the procedures.