Same Problem, Different Solution

Disclosure: Dr. Heuser reports he is co-developer of the Prodigy Support Catheter. Dr. Richard Heuser can be contacted at rheuser@phoenixheartcenter.com.

We read with interest Dr. Pancholy’s article about enhanced guiding catheter support, and we agree wholeheartedly with Dr. Pancholy that in complex percutaneous coronary intervention (PCI) via transradial access, guiding catheters that are 6 French are adequate in almost all cases.¹ When guiding catheter support is insufficient or there is concern about aggressive guidewire and guide catheter maneuvering during the procedure putting a patient at risk for ostial native coronary dissection, another option is feasible at this time.

The recently introduced Prodigy support catheter (Radius Medical) can be utilized both with complex percutaneous transluminal coronary angioplasty (PTCA) as well as in chronic total occlusion (CTO) cases (Figure 1). The illustrated case describes its utilization (Figures 2-4). We found the Prodigy to be effective not only in the femoral approach, but it also seems to be ideal for the radial approach.^2-3 We have performed 9 Prodigy CTO procedures successfully: 7 right coronary artery, 1 left anterior descending coronary artery (LAD), and 1 circumflex. As seen from the illustration, the guiding catheter is not even engaged aggressively, reducing the likelihood of multiple utilizations because of dissection or even more complicated tear of the proximal vessel.  

The advantage of the Prodigy catheter as opposed to a standard anchor and balloon technique is that with most over-the-wire balloons their tip is too long, and more importantly, the balloon can be traumatic and balloon diameters are very limited.⁴ The Prodigy device goes from 1mm up to 6mm, and is approximately 4mm in length. It would be ideal in placement of a conus branch or in a proximal vessel, and the elastomeric nature of the balloon makes it less traumatic and less likely to cause dissection. We found it be very useful in complicated lesions such as CTOs.

Device delivery can be enhanced with devices such as the Prodigy as well as the GuideLiner (Vascular Solutions) in complex intervention, including CTOs.

References

1. Pancholy S. Enhancing guide support during a complex coronary intervention via transradial approach. Cath Lab Digest. 2014 June; 21(6). Available online at https://www.cathlabdigest.com/articles/Enhancing-Guide-Support-During-Complex-Coronary-Intervention-Transradial-Approach. Accessed February 17, 2015.
2. Moualla S, Heuser RR. The utility of the Prodigy balloon in chronic total occlusion. Vascular Disease Management Blog, May 2014. Available online at https://www.vasculardiseasemanagement.com/blog/utility-prodigy-balloon-chronic-total-occlusion. Accessed February 17, 2015.
3. Moualla SK, Khan S, Heuser RR. Anchoring improved: introduction of a new over-the-wire support balloon. J Invasive Cardiol. 2014 Sep; 26(9): E130-E132.
4. Fujita S, Tamai H, Kyo E, Kosuga K, Hata T, Okada M, Nakamura T, Tsuji T, Takeda S, Bin Hu F, Masunaga N, Motohara S, Uehata H. New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty:  the anchor technique. Catheter Cardiovasc Interv. 2003 Aug; 59(4): 482-488.