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[Stiffened triple axial catheterization of tortuous cervivoencephalic vessels]
S Slaba1, S Sfeir, J Nassar-Slaba
1Service d'lmagerie Médicale, Hôtel-Dieu de France, Beyrouth, Liban. sslaba@hotmail.com
Insights
A novel "triple axial system" effectively navigated tortuous cervicoencephalic vessels for aneurysm embolization. This technique provides robust support, overcoming challenges in complex vascular anatomy during interventional procedures.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Cervicoencephalic vessel tortuosity complicates interventional procedures, leading to failure in 4-6% of cases.
- Challenges include material slippage, kinking, and difficulty advancing devices like balloons, stents, or microcatheters.
Observation:
- A case report details a patient with extreme vascular tortuosity requiring embolization of a ruptured left inferior cerebellar artery aneurysm.
- Standard access failed; a "triple axial system" was employed using a long 7F sheath in the left subclavian artery and a stiff guidewire.
Findings:
- A 4F catheter was advanced through the sheath to the mid-vertebral artery, facilitating microcatheter-microguide system navigation to the aneurysm.
- The system's stiffness neutralized backward tendency, enabling successful advancement.
- The guidewire acted as an external rail, mitigating risks like vasospasm, clotting, or dissection.
Implications:
- This technique offers strong backup support for complex vascular interventions.
- Further studies in larger series are needed to confirm the efficiency and safety of this low-risk solution for challenging vascular anatomies.
Abstract:
Tortuous anatomy of the cervicoencephalic vessels can cause failure in 4 to 6% of interventional procedures by slippage of the material back in the aorta, kinking or difficulty to move forward a balloon. stent or microcatheter. We report on an old patient with high vascular tortuosity, referred for embolization of a ruptured aneurysm of the left inferior cerebellar artery. Access wasn't possible until we used a "triple axial system" with a long 7F sheath, positioned in the left subclavian artery and strongly supported by a super stiff guidewire with its distal end floating freely in the vascular lumen. Inside the sheath and parallel to the guidewire, we pushed a 4F catheter till the mid-vertebral artery. The microcatheter-microguide system tracked through it, towards the aneurysm, with the backward tendency being neutralized by the increased stiffness. Our technique presents the advantage of a strong back-up support, without increased risks such as vasospasm, clotting or dissection, since the guidewire serving as a stiff rail, lies exteriorly to the navigated vessel. Efficiency of this elegant and relatively low risk solution has yet to be proved in larger series.
