Guide extension (GE) catheters are essential tools in modern percutaneous interventions, with their role becoming crucial in radial interventions where there is less guiding catheter backup support and with increasing complexity of coronary artery disease. GE catheters can be very helpful to facilitate equipment, delivery, aid coronary engagement, retrieve trapped equipment, and deliver drugs/aspirate thrombus in the distal portions of the coronary bed. GE catheters have been used for nearly a decade, with the first in-human experience reported in 2010 [ 1 ]. Several GE catheters (GuideZilla, GuideLiner, Telescope, TrapLiner) are available that facilitate the delivery of balloons and stents in complex lesions. These devices need to be handled cautiously to prevent serious complications.