Cathétérisme triple axial renforcé des tortuosités cervico-encéphaliques

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. (J Mal Vasc; 2005; 30: 118-121)