FIG 3. Coaxial double–guiding catheter technique.

A, Anteroposterior left ICA angiogram shows >80% stenosis (arrow) of the M1 portion of the MCA.

B, Lateral left ICA angiogram shows marked tortuosity of the ICA.

C, After the standard, waiting, and double-wire techniques fail, an 8F guiding catheter (black arrow) is positioned in the proximal cervical ICA, and a 5F guiding catheter (white arrow) is coaxially inserted within it.

D, Anteroposterior magnified view shows that the balloon-mounted stent cannot cross the acute angle (black arrow) of the cavernous ICA. Second wire (white arrow) is inserted across the curve.

E, Navigation of the stent-delivery system into the target lesions is successful with the coaxial double–guiding catheter and double-wire techniques.

F, Anteroposterior left ICA angiogram obatined immediately after stent placement shows sufficient and smooth dilatation of the stenotic segment.