Neuroform Atlas stent in treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries: a single-centre experience

Delayed Iatrogenic Dissection Caused by a Carotid Stent: A Case Report

Iatrogenic dissection (ID) is a well-known complication of neuroendovascular treatments. ID is predominantly attribute to endothelial injury by the manipulation of wires and/or catheters, and is generally detected in angiography during the procedure. We present a rare case with delayed ID due to deployment of a carotid stent. A 71-year-old man presented with transient motor weakness in the right extremity. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) showed previous multiple cerebral infarctions without a diffusion sign, stenosis with vulnerable plaque in the left common carotid artery (CCA), and an extremely flexed internal carotid artery (ICA). On dual antiplatelet medication, carotid artery stenting (CAS) was completed with favorable dilation of the carotid lumen. Computed tomography angiography 4 days after the procedure revealed high-grade stenosis at the ICA adjacent to the distal edge of the deployed stent. ID with intramural hematoma was diagnosed on MRI. The ID was conservatively treated and remarkably diminished 4 months after the procedure. The patient was asymptomatic during the entire clinical course. This delayed ID was considered to be due to an endothelial injury caused by the distal edge and the constant radial force of the open-cell stent against the flexed vessel and exacerbated by dual antiplatelet therapy. Even in a patient with favorable arterial dilation in CAS procedure, the possibility of a delayed ID should always be considered.

Bilateral Transradial Approach for Coil Embolization of Basilar Artery Aneurysms Associated with an Unfavorable Vertebral Artery Anatomy : Initial Experience with Role-sharing Technique

PURPOSE

An unfavorable vertebral artery (VA) anatomy occasionally inhibits a successful VA cannulation due to flow stagnation after catheterization. To preserve antegrade VA flow, we developed bilateral transradial catheter systems, referred to as the role-sharing technique, for coil embolization of basilar artery (BA) aneurysms associated with an unfavorable VA anatomy. This study aimed to evaluate the feasibility and safety of coil embolization using the role-sharing technique for BA aneurysms.

METHODS

We retrospectively analyzed an institutional database of consecutive patients with BA aneurysm who underwent coil embolization using the role-sharing technique between July 2019 and January 2020. The study included seven consecutive patients. Bilateral transradial VA cannulation was performed using 3.2F catheters (TACTICS; Technocrat Corporation, Aichi, Japan) via 4F guiding sheaths placed in the subclavian artery. The following catheter systems were used: the triaxial system (4F guiding sheath/TACTICS/coil or stent delivery microcatheter) that has a specialized role in embolization and the biaxial system (4F guiding sheath/TACTICS) that has a specialized role in contrast injection during embolization procedure. The procedural success and procedure-related or vascular access site complications were assessed.

RESULTS

All patients underwent a successful embolization procedure using the bilateral transradial catheter systems and none of them presented with flow stagnation, system instability, or other complications.

CONCLUSION

The role-sharing technique was shown to be a feasible and safe method for coil embolization of BA aneurysms associated with an unfavorable VA anatomy. This method may increase the success rate of transradial coil embolization for BA aneurysms.