J Korean Radiol Soc.  2005 Feb;52(2):101-106. 10.3348/jkrs.2005.52.2.101.

New Techniques for Intracranial Stent Navigation in Patients with Tortuous Arteries

• Choi HW
• Koo YB
• Lee TH
• Kim HJ
• Lee JW
• Kim CW
• Kim S
• Choo KS
• Jeong YJ
• Lee SH

• KMID: 1945421
• DOI: http://doi.org/10.3348/jkrs.2005.52.2.101

Abstract

PURPOSE: We wanted to describe several new techniques of intracranial stenting that are helpful for navigating the stent delivery system in the tortuous carotid or vertebral arteries.
MATERIALS AND METHODS
Between May 1998 and June 2004, 65 patients with 73 symptomatic, stenotic intracranial arteries (more than 50%) were successfully treated with stent-assisted angioplasty. In eleven of the total cases, the standard technique failed to navigate the stent delivery system into the objective lesion because of the tortuous path of the carotid or vertebral arteries. In these cases, several new techniques were used to overcome the vessels' tortuous path. The several new techniques were 1) the waiting method (20-30 minutes) after advancement of microwire across the lesion; 2) the double wires technique using an additional microwire; and 3) the coaxial double guiding catheters technique using an additional smaller guiding catheter. 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, intracranial artery stenting was performed successfully by using the several new techniques. The waiting method made smooth stent navigation possible in 5 cases, the double wire technique was successful in 4 cases and the coaxial double guiding catheter technique was successful in 2 case. There was no complication related to the new techniques.
CONCLUSION
In difficult cases where the standard technique failed to navigate the stent delivery system into the objective lesion because of the vessels' tortuous path, these new techniques for intracranial stent navigation were usefully implemented.

Keyword

Angioplasty; Intracranial atherosclerosis; Stents

MeSH Terms

Angioplasty
Arteries*
Carotid Artery, Internal
Catheters
Humans
Intracranial Arteriosclerosis
Middle Cerebral Artery
Stents*
Vertebral Artery