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Published on: May 14, 2013
Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note
Tomoki Koide1, Yoshiro Ito1, Tenyu Hino2
1Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Insights
A novel "snake hunt technique" successfully straightened a highly tortuous carotid artery, enabling stent insertion. This method offers a solution for challenging carotid artery stenting (CAS) cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Carotid artery stenosis (CAS) poses challenges, especially with highly tortuous vessels, complicating the use of rigid devices like stents.
- Existing adjunctive guidewire techniques (buddy wire, sheep, stiff guide) may not always overcome severe vessel tortuosity during CAS.
- Difficulty in device navigation can lead to procedural failure or suboptimal stent placement in complex carotid anatomy.
Purpose of the Study:
- To describe a novel technique for navigating and treating highly tortuous carotid artery stenosis during CAS.
- To present a case demonstrating the successful application of the "snake hunt technique" for stent delivery.
- To propose this technique as a potential troubleshooting solution for challenging CAS procedures.
Main Methods:
- A 64-year-old male patient with amaurosis and severe left carotid stenosis underwent CAS.
- Initial stent placement resulted in proximal vessel kinking, preventing further device insertion despite standard adjunctive techniques.
- The novel "snake hunt technique" involved inflating a proximal balloon and retracting it to straighten the tortuous segment, facilitating stent delivery.
Main Results:
- The "snake hunt technique" successfully straightened the severely kinked and tortuous carotid artery segment.
- This maneuver enabled the successful insertion of the second stent, resolving the procedural difficulty.
- The patient's amaurosis and transient ischemic symptoms were addressed by the successful CAS.
Conclusions:
- The "snake hunt technique" is an effective method for managing severe tortuosity during carotid artery stenting.
- This technique provides a valuable option when standard adjunctive guidewire methods fail to facilitate stent or balloon delivery.
- The successful application highlights its potential as a critical troubleshooting step in complex CAS procedures.
Abstract:
In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the "snake hunt technique" because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.
