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
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FIG 1. Waiting method. A, Anteroposterior left ICA angiogram shows >60% stenosis (arrow) of the M1 portion of the MCA.
B and C, Standard technique for stent navigation failed (not shown). Anteroposterior views obtained after the stent-delivery system was withdrawn show the angled microwire in the cavernous ICA (arrows).
D, After 20 minutes of waiting, anteroposterior view shows that the angle of microwire changed (black arrow), and navigation of the delivery system (white arrow) into the target lesion is successful.
E, Balloon-mounted coronary stent is successfully deployed (arrow).
F, Anteroposterior left ICA angiogram after stent placement reveals sufficient and smooth dilatation of the stenotic segment (arrow).
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FIG 2. Double-wire technique.
A, Lateral left ICA angiogram shows >70% stenosis (arrow) of the supraclinoid portion.
B, Lateral magnified view shows that the balloon-mounted stent cannot cross the acute angle (arrow) of the cavernous ICA.
C, Navigation of the stent-delivery system into the target lesion (arrows) is successful.
D, Balloon-mounted coronary stent (arrows) is successfully deployed. No procedure-related complication occurred.
E and F, Anteroposterior (E) and lateral (F) left ICA arteriograms obtained immediately after stent placement show sufficient and smooth dilatation of the stenotic segment.
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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.
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