Article Figures & Data
Figures
- 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 Anteroposterior views obtained after the stent-delivery system was withdrawn show the angled microwire in the cavernous ICA (arrows).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).
- 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.
- 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.
Tables
Summary of 11 patients receiving intracranial stents
Patient/Age(y)/Sex Lesion location Stenosis (%) Stent and Size (mm)* Technique Technical Success 1/71/M L MCA 70 S660, 2.5 × 9 Waiting Yes 2/74/F R MCA 70 S660, 2.5 × 15 Coaxial double—guiding catheter Yes 3/76/F L distal VA 60 S660, 2.5 × 15 Double wire Yes 4/77/F L supraclinoid ICA 60 Flexmaster, 2.75 × 12 Waiting Yes 5/74/F R supraclinoid ICA 70 Flexmaster, 3.0 × 12 Waiting Yes 6/71/F L MCA 60 S660, 2.5 × 11 Waiting Yes 7/70/F L distal VA 80 Flexmaster, 3.0 × 16 Waiting Yes 8/53/M L MCA 80 Flexmaster, 2.5 × 16 Coaxial double–guiding catheter Yes 9/51/M L MCA 70 Flexmaster, 2.5 × 12 Double wire Yes 10/42/F L supraclinoid ICA 75 Flexmaster, 2.75 × 23 Double wire Yes 11/47/M L supraclinoid ICA 100 Flexmaster, 2.5 × 26 Double wire Yes * Diameter × length. S660 made by Medtronic; Flexmaster, Jo Med GmbH.
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