Guideliner catheter--friend or foe?

Performing percutaneous coronary intervention (PCI) in arteries with complex anatomy remains a clinical problem. In particular tortuosity within a coronary vessel is frequently encountered and can hamper delivery of balloons or stents to coronary stenoses. This has led to the development of a number of adjuvant devices to assist stent delivery in difficult cases. The safety profile of these novel devices remains to be clearly ascertained. The Guideliner "child" support catheter is one such device and comprises of a 20-cm silicon-coated guide extension that assists delivery of stents in tortuous arteries when conventional techniques have failed. Initial reports suggest it is efficacious and no previous complications relating to the device have been published. We report the first complication involving the Guideliner catheter which was encountered during primary PCI. We hypothesize regarding the mechanism of the complication and discuss the ways it may be avoided in the future.