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American Journal of Neuroradiology 26:1375-1380, June-July 2005
© 2005 American Society of Neuroradiology

INTERVENTIONAL

Techniques for Intracranial Stent Navigation in Patients with Tortuous Vessels

Tae Hong Leea, Chang Hwa Choib, Kyung-Pil Parkc, Sang Min Sungd, Sang Won Leeb, Byung-Hee Leee, Dong Hyun Kimf, Hak Jin Kima, Chang Won Kima and Suk Kima

a Department of Diagnostic Radiology, College of Medicine, Pusan National University Hospital, Republic of Korea
b Department of Neurosurgery, College of Medicine, Pusan National University Hospital, Republic of Korea
c Department of Neurology, College of Medicine, Pusan National University Hospital, Republic of Korea
d Department of Neurology, Pusan Medical Center, Republic of Korea
e Department of Diagnostic Radiology, Metrohospital, Anyang, Republic of Korea
f Department of Diagnostic Radiology, College of Medicine, Chosun University Hospital, Kwangju, Republic of Korea

Address reprint requests to Byung-Hee Lee, MD, Department of Diagnostic Radiology, Metrohospital, 324-105, Anyang 8-Dong, Manan-Gu, Anyang, Kyonggi-Do, 430-720, Republic of Korea

BACKGROUND AND PURPOSE: In some patients with stenosis of an intracranial artery, navigating the balloon or stent-delivery system is difficult of tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries Our purpose was to describe techniques of intracranial stent placement that help in navigating the stent-delivery system in tortuous vessels.

METHODS: Between May 1998 and June 2004, 73 symptomatic stenotic (>50%) intracranial arteries were successfully treated with stent-assisted angioplasty. In 11 cases, standard techniques of navigating the stent-delivery system into the intended lesion failed because of vascular tortuosity. In these difficult cases, several techniques were used to overcome the tortuosity. Five lesions were located in the middle cerebral arteries, four were in the supraclinoid internal carotid arteries, and two were in the distal vertebral arteries.

RESULTS: In all difficult cases, stents were successfully placed in the intracranial artery by using several techniques: 1) waiting method in which we waited for 20–30 minutes after advancement of the microwire across the lesion, 2) the double-wire technique, and 3) the coaxial double–guiding catheter technique. The waiting method made smooth stent navigation possible in five cases, the double-wire technique was successful in four cases, and the coaxial double–guiding catheter technique was effective in two cases. No technique-related complications occurred.

CONCLUSION: In difficult cases in which standard techniques of navigating the stent-delivery system into the intended lesion fail because of vascular tortuosity, our techniques were useful methods for intracranial stent navigation.






Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X