{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:03:00Z","timestamp":1771225380539,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Transfemoral Impella placement can be technically challenging in patients with severe iliofemoral tortuosity and calcification, often leading to sheath kinking, failed device advancement and vascular complications. In this complex, high\u2010risk percutaneous coronary intervention (PCI) case, Impella CP insertion was impeded by severe tortuosity. The issue was successfully addressed by exchanging the standard Impella 14 French sheath with a 16 French Gore DrySeal sheath, which enabled smooth device delivery and completion of PCI. The Gore DrySeal sheath, originally designed for complex aortic procedures, offers enhanced flexibility, kink resistance, and hydrophilic coating that improve trackability in tortuous anatomy. Review of the literature supports its off\u2010label use in similar challenging vascular access scenarios. This case highlights the potential role of the Gore DrySeal sheath as a valuable tool in facilitating large\u2010bore device placement through complex arterial pathways.<\/jats:p>","DOI":"10.1002\/ccd.31695","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T04:50:14Z","timestamp":1750395014000},"page":"1433-1436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Troubleshooting Vascular Tortuosity in High Risk Percutaneous Coronary Intervention: Managing Impella Sheath Challenges"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6266-4991","authenticated-orcid":false,"given":"AlMothana","family":"Manasrah","sequence":"first","affiliation":[{"name":"Department of Internal Medicine United Health Services\u2014Wilson Medical Center Johnson City Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer","family":"Akel","sequence":"additional","affiliation":[{"name":"Department of Cardiology St Joseph's University Medical Center Paterson New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Firas","family":"Qaqa","sequence":"additional","affiliation":[{"name":"Department of Cardiology Holy Name Medical Center Teaneck New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13164586"},{"key":"e_1_2_10_3_1","unstructured":"M.GriseandR. A.Badawi \u201cAccess and Closure Techniques With the Impella Left Ventricular Assist Device [Internet] \u201d cited April 14 2025 https:\/\/www.hmpgloballearningnetwork.com\/site\/cathlab\/articles\/access-closure-techniques-impella-left-ventricular-assist-device."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2022.03.006"},{"key":"e_1_2_10_5_1","unstructured":"F.Ghanem A.Cheema andA. M.Hafiz \u201cTroubleshooting a CP Impella Sheath\u2014Overcoming [Internet] \u201d cited April 14 2025 https:\/\/www.jacc.org\/doi\/10.1016\/S0735-1097%2825%2903867-7."},{"key":"e_1_2_10_6_1","unstructured":"W. L. Gore & Associates \u201cImproved GORE DrySeal Sheath With Hydrophilic Coating Launches in Europe [Internet] \u201d cited April 14 2025 https:\/\/www.goremedical.com\/ap\/news\/dryseal-sheath-with-hydrophilic-coating-launch."},{"key":"e_1_2_10_7_1","unstructured":"W. L. Gore & Associates \u201cGORE DrySeal Flex Introducer Sheath\u2014Gore Medical [Internet] \u201d cited April 14 2025 https:\/\/www.goremedical.com\/products\/dryseal."},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.14503\/THIJ-14-4337"},{"issue":"1","key":"e_1_2_10_9_1","first-page":"1","article-title":"Initial Experience: The Use of Novel Balloon Expandable Sheaths With the Impella 2.5L Catheter During High Risk Percutaneous Coronary Intervention","volume":"1","author":"Nguyen J.","year":"2015","journal-title":"Clinical Research and Trials [Internet]"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.32604\/CHD.2021.015222"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvssci.2023.100127"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.4186"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2022.12.005"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2019.11.085"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31695","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.31695","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:03:55Z","timestamp":1771221835000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.31695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,20]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/ccd.31695"],"URL":"https:\/\/doi.org\/10.1002\/ccd.31695","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,20]]},"assertion":[{"value":"2025-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}