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Yi HJ, Kim BT, Shin DS. Effectiveness of Anchoring with Balloon Guide Catheter and Stent Retriever in Difficult Mechanical Thrombectomy for Large Vessel Occlusion. J Korean Neurosurg Soc 2022; 65:514-522. [PMID: 35728980 PMCID: PMC9271811 DOI: 10.3340/jkns.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objective A distal navigation of a large bore aspiration catheter during mechanical thrombectomy (MT) is important. However, delivering a large bore aspiration catheter is difficult to a tortuous or atherosclerotic artery. We report the experience of anchoring with balloon guide catheter (BGC) and stent retriever to facilitate the passage of an aspiration catheter in MT. Methods When navigating an aspiration catheter failed with a conventional co-axial microcatheter delivery, an anchoring technique was used. Two types of anchoring technique were applied to facilitate distal navigation of a large bore aspiration catheter during MT. First, a passage of aspiration catheter was attempted with a proximal BGC anchoring technique. If this technique also failed, another anchoring technique with distal stent retriever was tried. Consecutive patients who underwent MT with an anchoring technique were identified. Details of procedure, radiologic outcomes, and safety variables were evaluated. Results A total of 67 patients underwent MT with an anchoring technique. Initial trial of aspiration catheter passage with proximal BGC anchoring technique was successful for 35 patients (52.2%) and the second trial with distal stent retriever anchoring was successful for 32 patients (47.8%). Overall, navigation of a large bore aspiration catheter was successful for all patients (100%) without any procedure related complications. Conclusion Our study showed the usefulness of anchoring technique with proximal BGC and distal stent retriever during MT, especially in those with an unfavorable anatomical structure. This technique could be an alternative option for delivering an of aspiration catheter to a distal location.
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Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.,Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dong-Sung Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Koide T, Ito Y, Hino T, Sato M, Marushima A, Hayakawa M, Matsumaru Y, Ishikawa E. Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note. NMC Case Rep J 2022; 8:387-391. [PMID: 35079493 PMCID: PMC8769477 DOI: 10.2176/nmccrj.tn.2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022] Open
Abstract
In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the "snake hunt technique" because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.
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Affiliation(s)
- Tomoki Koide
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tenyu Hino
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Dobrocky T, Lee H, Nicholson P, Agid R, Lynch J, Swaminathan SK, Krings T, Radovanovic I, Pereira VM. When Two Is Better than One : The Buddy-wire Technique in Flow-diversion Procedures. Clin Neuroradiol 2021; 32:491-498. [PMID: 34236441 PMCID: PMC9187555 DOI: 10.1007/s00062-021-01053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
Background Delivery of most flow diverters (FD) requires larger, and thus stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, also known as the buddy-wire technique, may be helpful for navigation and support in challenging situations. Methods We analyzed all flow diverter procedures in our prospectively collected database. We recorded all patient-related, anatomical and procedural information. We performed univariate statistics and technical descriptions. Results In total, 208 consecutive patients treated with a FD at our institution between July 2014 and August 2020 were retrospectively analyzed. In 17 patients the buddy-wire technique was used (mean age 63 years, range 31–87 years: 16 female). Aneurysms were located at the petrous, cavernous, supraophthalmic internal carotid artery, and a proximal M2 branch in 2, 7, 7 and 1 patient(s), respectively. In all cases a 0.027in. microcatheter was used for device deployment. In 14 patients with a wide-necked aneurysm the buddy-wire provided additional support to advance the microcatheter and mitigated the ledge between the aneurysm neck and the parent artery or a side branch. In two giant cavernous aneurysms treated with telescoping FDs, the buddy-wire was used to re-enter the proximal end of the foreshortened FD. Conclusion The buddy-wire is a useful technique in FD procedures to prevent herniation of the microcatheter into the aneurysm sack, in wide-necked aneurysms to mitigate the ledge effect between the aneurysm neck and the parent artery where the microcatheter tip may get stuck, or to enable re-entry into a foreshortened FD.
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Affiliation(s)
- Tomas Dobrocky
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada. .,University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Hubert Lee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
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Abstract
Symptomatic vertebral artery stenosis is associated with high risk of early recurrent stroke. Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results. In this review we outline the framework for the diagnosis and management of vertebral artery disease with focus on the emerging benefits of angiography and endovascular interventions.
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Affiliation(s)
| | - J Stephen Jenkins
- Department of Interventional Cardiology, Ochsner Medical Center, New Orleans, LA, USA.
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Kuriyama E, Matsuda Y, Kawaguchi T, Yako R, Nakao N. Analysis of the Anatomical Factors Affecting Ability to Navigate Penumbra Catheter through Internal Carotid Siphon. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:169-176. [PMID: 37502688 PMCID: PMC10370674 DOI: 10.5797/jnet.oa.2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/25/2020] [Indexed: 07/29/2023]
Abstract
Objective The efficacy and safety of aspiration thrombectomy using Penumbra catheter with acute large vessel occlusion in the anterior circulation have been reported in previous studies. In some cases, the carotid siphon (CS) is elongated, and with this anatomy, especially where there is bifurcation of the ophthalmic artery (OA), navigation of Penumbra catheters into distal internal carotid artery (ICA) is interrupted, which is known as the 'ledge effect'. We investigate the anatomical characteristics of CS that cause interruption of navigation of the Penumbra catheter. Methods Between January 2015 and March 2018, mechanical thrombectomy using Penumbra 60 was performed on 51 patients with middle cerebral artery (MCA) or intracranial ICA occlusion. Patients were divided into two groups: The 'ledge-effect' group those in whom the Penumbra catheter was unable to be navigated into the distal ICA through the CS, and 'no ledge-effect' group those in whom this was possible. The anatomical characteristics of CS, the diameter of ICA, diameter of OA, OA/ICA ratio and radius of the CS were evaluated using angiographical imaging. Results The 'ledge-effect' group numbered eight cases (17%). Only the value of the CS radius was significantly smaller in the ledge-effect group (p = 0.0019), other parameters were not significantly different between the groups. The cutoff radius value was 3.62 mm. Conclusion The most notable anatomical factor affecting possibility of navigation of the Penumbra catheter through the CS was the CS radius. This could be useful information when devices used in mechanical thrombectomy are selected.
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Affiliation(s)
- Emi Kuriyama
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Yoshikazu Matsuda
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Takumi Kawaguchi
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Rie Yako
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Naoyuki Nakao
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Wakayama, Japan
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NII K, ABE G, IKO M, NOMOTO Y, YU I, SAKAMOTO K, KAZEKAWA K. Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium. Neurol Med Chir (Tokyo) 2013; 53:422-6. [DOI: 10.2176/nmc.53.422] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kouhei NII
- Department of Neurosurgery, Fukuoka Kieikai Hospital
| | - Gorou ABE
- Department of Neurosurgery, Fukuoka Kieikai Hospital
| | - Minoru IKO
- Department of Neurosurgery, Fukuoka Kieikai Hospital
| | | | - Iwae YU
- Department of Neurosurgery, Fukuoka Kieikai Hospital
| | - Kimiya SAKAMOTO
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
| | - Kiyoshi KAZEKAWA
- Department of Neurosurgery, Fukuoka University Chikushi Hospital
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