Key result
A microcatheter telescopic system was successfully used in 89 out of 1,225 procedures (7.3%) to reach difficult targets in complex congenital heart disease, facilitating various interventions.
Why the study?
Does a microcatheter telescopic system improve access to difficult targets in complex congenital heart disease interventions?
Observational (n=1,225)
Does a microcatheter telescopic system improve access to difficult targets in complex congenital heart disease interventions?
A microcatheter-telescopic system is an effective tool for reaching difficult targets and delivering interventions in complex congenital heart disease.
May facilitate access in select complex congenital cases; hypothesis-generating and requires prospective validation before wider use.
BACKGROUND: Some lesions can be very difficult to reach, especially if acute angles and/or multiple turns "protect" access. Once reached, the guiding system needs to give sufficient support for balloons or stents to be deployed. METHODS: A "telescopic" system was created consisting of: (1) a microcatheter with guidewire. This system fits into any catheter allowing a 0.035 inch wire. (2) a 4Fr "delivery" catheter. (3) If sharp angles were encountered, the 4Fr catheter was deployed through a 6Fr or larger angulated guiding sheath. This was cut-off 15 cm out of the groin and re-valvulated with a standard short introducer sheath. PATIENTS AND RESULTS: Since 2004, 89 microcatheter telescopic systems were used during a 4-year period in 1,225 procedures (7.3%). The technique allowed probing with a floppy steerable and exchangeable guidewire, securing any gained position as well as exchanges with a stiffer guide wire if required. Procedures where the telescopic system was effective included: complex stenoses e.g. aortopulmonary collaterals (n = 21), tortuous ducts (n = 9), anterograde balloon dilation of critical aortic stenosis (n = 8) and crossing Blalock Taussig shunts (n = 3). Once in place, the telescopic system allowed delivery of embolic material (n = 38), balloon angioplasty (n = 21), stent deployment (n = 23), fulguration of pulmonary valve (n = 1) or introduction of medication (n = 1). The interventionalists felt that using the telescopic system had reduced fluoroscopy and procedure time. CONCLUSIONS: The microcatheter-telescopic system is an invaluable tool to reach difficult targets and allows exchange for suitable guidewires permitting balloons, stents, embolisation material or radiofrequency energy to be deployed in such targets. This approach has become our standard when dealing with difficult targets protected by a tortuous route.
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Brown et al. (2008) conducted an observational in Complex congenital heart disease (n=1,225). Microcatheter telescopic system was evaluated on Successful probing and delivery of interventional equipment to difficult targets. A microcatheter telescopic system was successfully used in 89 out of 1,225 procedures (7.3%) to reach difficult targets in complex congenital heart disease, facilitating various interventions.
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