Are catheter extension devices one step forward for complex coronary interventions?

Complex percutaneous coronary interventions (PCI) are increasing day by day. However, there are still some anatomical features (such as marked calcification, tortuosity, and chronic total occlusions) that remain a challenge for the delivery of angioplasty balloons and stents, leading to a considerable percentage of stent deployment failure (around 3–5%) (1). In this context, there are several techniques aimed at improving PCI success, which can be grouped into three categories: i) increase in back-up support, mainly driven by guide catheter, ii) increase in guidewire support (stiffer wires, “buddy wire,” anchoring, etc.), and iii) plaque modification (aggressive predilatation, cutting balloon, rotational atherectomy, etc.) (2–4). All of them are useful in daily clinical practice as complementary strategies; nevertheless, there is no evidence of direct comparison among them. Back-up support depends on two components: passive support given by the guide back-up against the opposite aortic wall and the stiffness of the guide, and active support achieved by coaxiality and deep engagement of the guide. Among these techniques, there are guide catheter extension devices, such as the GuideLiner？ catheter (Vascular Solutions Inc.), that allow a deep intubation and provide greater support and coaxiality while the guiding catheter remains steady in the aorta (5)