J Cerebrovasc Endovasc Neurosurg.  2017 Mar;19(1):12-18. 10.7461/jcen.2017.19.1.12.

Prophylactic Dual Catheter Technique to Prevent Side Branch Snowplowing Complications during Angioplasty and Stenting

• Yeo LL
• Wu WM
• Chen YL
• Yeh CH
• Wong HF

• KMID: 2377622
• DOI: http://doi.org/10.7461/jcen.2017.19.1.12

Abstract

OBJECTIVE
Angioplasty and Stenting of intracranial atherosclerotic lesions have a higher complication rate and a large proportion of this is attributable to side branch arterial occlusion from forceful displacement of the atheroma into the ostia or snowplowing effect. This can result in severe disabilities when it result in small infarcts involving eloquent areas in the posterior circulation or the motor tracts.
MATERIALS AND METHODS
We present a series of 6 cases utilizing a new dual catheter technique for maintaining the patency of at-risk vessels during angioplasty and stenting. There are several methods previously described to help reduce the incidence of stroke but because they do not have a physical presence in the ostia to protect it, they are unable to guarantee the patency of the vessel.
RESULTS
All 6 patients underwent angioplasty and stenting with the technique. The patients were assessed for complications with post-procedure magnetic resonance imaging and no complications were found.
CONCLUSION
In this preliminary series, the dual catheter technique appears to safe and effective in preventing occlusion of the adjacent branch arteries. This technique may facilitate the use of the Wingspan stent in the treatment of intracranial atherosclerotic stenotic segments by reducing the risk of peri-procedural stroke.

Keyword

Intracranial stenosis; Stenting; Technique; Stroke; Complications

MeSH Terms

Angioplasty*
Arteries
Catheters*
Humans
Incidence
Magnetic Resonance Imaging
Plaque, Atherosclerotic
Stents*
Stroke

Figure

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  Fig. 1 (A) Right Vertebral stenosis with at-risk PICA artery. (B) 3-D reconstruction of the stenosis and PICA. (C, D) Echelon-10 microcatheter advanced into PICA and left to protect it, superselective contrast injection by hand to confirm placement. (E) Final outcome after angioplasty and stenting, PICA is preserved. PICA = posterior inferior cerebellar artery.

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  Fig. 2 (A) Right Vertebral stenosis with at-risk PICA artery. (B) Double microcatheters in R VA & PICA. (C) Double microcatheters in R VA & PICA with check angiographic run. (D) 3-D reconstruction post-angioplasty & stenting. (E) Final outcome after angioplasty and stenting, PICA is preserved. VA = vertebral artery; PICA = posterior inferior cerebellar artery.

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