Successful stent delivery with deep seating of 6 French guiding catheters in difficult coronary anatomy

Despite improvements in coronary stent design, delivery difficulties may st ill be encountered. Between April 1996 and September 1998, 945 patients und erwent coronary stenting in our Institute. New 6 Fr Long Brite Tip (LBT) gu iding catheters, allowing deep coronary artery intubation and increased bac kup support, were used in 25 (2.6%) of these patients presenting complex co ronary anatomy and poor stent accessibility, electively in 3 (12%) and afte r stent delivery failure with multiple (2.1 +/- 1.2) standard guiding cathe ters in 22 (88%). Deep coronary artery intubation (greater than or equal to 20 mm) was successfully performed in 22 (88%) patients and was associated with adequate pressure recording and contrast opacification without blood f low compromise. Ten (22.7%) Palmaz-Schatz stents and 34 (77.3%) second-gene ration stents of various lengths were successfully delivered to different c oronary vessels (RCA = 15, LAD = 9, Lcx = 1) in all patients in whom deep c oronary intubation was obtained. These data demonstrate that deep coronary artery cannulation with LBT catheters is feasible and safe and may markedly increase the rate of stent delivery success in very complex coronary anato my and when standard guiding catheters have failed. Cathet. Cardiovasc. Int ervent 48:279-284, 1999. (C) 1999 Wiley-Liss, Inc.