Bailout Guiding Catheter Exchange Using Medilizer: A Case Report

Medilizer (Medikit, Tokyo, Japan) is a distal anchoring exchange wire equipped with a soft, flexible self-expanding stent at the distal tip, designed to facilitate exchange maneuvers and device delivery. We report the use of the Medilizer for bailout guiding catheter exchange while preserving distal access.

A 72-year-old man presented with progressive cerebral ischemia caused by acute right internal carotid artery (ICA) occlusion with contralateral chronic ICA occlusion. Percutaneous transluminal angioplasty (PTA) and Wingspan stent (Stryker Neurovascular, Fremont, CA, USA) placement in the right ICA were attempted under proximal balloon protection using a balloon-guiding catheter. After lesion crossing, the Medilizer was deployed from the proximal M2 to the proximal M1 segment. Cerebral angiography revealed severe cavernous ICA stenoses and multiple thrombi in the petrous ICA. During attempted PTA under proximal balloon protection, rupture of the balloon-guiding catheter necessitated an unexpected guiding catheter exchange. Because exchanging the entire system risked the loss of distal access, guiding catheter exchange was successfully attempted while maintaining the Medilizer in place using stepwise coaxial catheter advancement. Subsequent angioplasty and Wingspan stent placement achieved adequate revascularization without complications.

Medilizer may provide an effective bailout option for unexpected guiding catheter exchange after lesion crossing by preserving distal access during neuroendovascular procedures.