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When Shorter is Better: A Novel Technique for Shortening a Guide Catheter without Losing Guidewire Position

René Hameau D, Alberto Fuensalida A, Rodrigo Muñoz D, Martín Valdebenito T, José Luis Winter D, Nicolás Veas P, Jorge Quitral1 and Dante Lindefjeld C*

Background: The retrograde approach for percutaneous interventions of chronic total occlusions (CTO) is a challenging technique but it has helped to improve the overall success rates. Even with the use of specialized materials like short guide catheters and longer microcatheters or balloons, sometimes operators cannot obtain the sufficient length to reach the target lesion.

Description: We a retrograde intervention through a saphenous vein graft (SVG) where the CTO lesion was crossed with the guidewire but could not advance the rest of the equipment (microcatheter nor balloons) due to the length of the SVG. Guide catheter was shortened with a technique that uses the introducer needle as a shield to protect the guide wire and maintains position at all times. Then a radial sheath was connected directly to catheter to continue the procedure in a standard way.

Conclusion: The need for shortening a guide catheter is an uncommon situation during a CTO intervention and it can be really challenging in the scenario where the guideword is already across the lesion. In these cases, operators must know how to perform it quickly and safely. We describe a novel technique for shortening a guide catheter that is easy to learn and provides a helpful tip for this bailout situation.