PONTE VEDRA BEACH, FLA. — When a coronary artery is too tight to accommodate a stent, it may be necessary to apply a little grease.
A lubricant suited to the job was an olive oil and egg yolk phospholipid-based emulsion sold commercially as Rotaglide, Mark Awar, M.D., and associates reported in a poster at the annual meeting of the Society for Cardiovascular Angiography and Interventions.
The 20 patients in the series they reported on were those who failed initial stent placement out of 813 consecutive patients who underwent a percutaneous coronary intervention at Jefferson Medical College in Philadelphia.
In these 20 cases stent delivery was unsuccessful despite predilation and several other steps: substitution of a moderate-to-stiff guidewire, reattempts with a new guiding catheter or a new stent, use of a buddy wire, and in one case use of rotational atherectomy. After failed delivery, the stents were removed from their guiding catheters, saturated with Rotaglide using a 20-cc syringe, and a second delivery was immediately attempted.
Application of Rotaglide led to successful delivery for 17 of the 20 stents, reported Dr. Awar, a cardiologist at Jefferson. Angiography showed excellent anatomic results in all 17 patients. There were no major adverse coronary events or subacute stent thromboses.
All 20 patients had arteries with complex anatomy and unfavorable morphologic features: 17 (85%) had tortuous vessels, 13 (65%) had calcification, and 10 (50%) had diffuse disease (several patients had more than one feature). The target vessels included 10 left circumflex arteries, 8 right coronary arteries, and 2 left anterior descending arteries. Average patient age was 69 years, and 75% were men.
Use of Rotaglide to smooth the way for a stubborn stent had previously been reported in isolated case studies, but not in such a large series. Prior reports also have documented up to a 4% rate of failure in delivering stents to their target lesions (in this series the rate was 2.5%: 20 out of 813).
Rotaglide is sold by Boston Scientific to reduce catheter friction during rotational atherectomy.
The study was not sponsored by Boston Scientific.