Smart angiography suites (SAS) refer to the incorporation of audio-video technology and internet connectivity into the angiography suite to enable bidirectional communication for teleproctoring. Remote streaming support (RESS) is intended to increase patient safety by supporting interventionalists with limited experience or who are practicing in geographically remote areas. The aim of this review is to describe real-life experience of the Tegus system and to share practical tips concerning its use and setup. We describe the platform itself, settings and integration in our angiography suite. We provide technical tips intended to help new and potential users to achieve an optimal experience for both neurointerventionalists and proctors. We describe both elective cases that we have performed with teleproctoring and emergencies. Lastly, we describe a different room setup and software solutions used in live workshops. Use of teleproctoring enabled involvement of proctors in cases where an already experienced interventionalist needed support in the decision-making process concerning the sizing and deployment of devices with which he was familiar only on a basic level. Excellent video feed quality and instant communication enabled optimal preparation and in vivo implantation of those devices without the need for physical proctors’ presence. In emergency cases the system allowed a senior physician to offer support during cases where optimal device sizing is critical. Our usage concept of the rig permitted monitoring of thrombectomy cases by junior physicians. During webinars a remote streaming platform enabled us to conduct workshops that simulated an “on-site” experience as closely as possible during the COVID-19 pandemic.

ObjectiveTo report our early experience in using the steerable ‘Columbus’ guidewire, also known as ‘Drivewire’ in the USA, and its potential applications in neurovascular interventions.MethodsNeurointerventions in 36 patients (20 female, 16 male) using the steerable Columbus guidewire were recorded from August 2019 to December 2020 and included a variety of neurovascular procedures: Treatment of aneurysms (n=17), thrombectomy in acute ischemic stroke (n=12), and others (n=7), such as treatment of stenosis and embolization procedures. Immediate follow-up with digital subtraction angiography and tracking of each patient’s clinical outcome was performed.ResultsIn 35 out of 36 cases, the target vessel was reached with Columbus, including advancement of the appropriate microcatheter. In 14 cases, additional wires were used, mainly because of the nature of the procedures (eg, use of multiple wires/buddy wires or exchange maneuvers). In five cases, the Columbus wire was damaged by the operator and had to be replaced. Peri-interventional complications occurred in two patients, neither attributed to the Columbus guidewire.ConclusionsThe new Columbus neurovascular guidewire has the unique ability to be shaped within the patient. Currently available versions lack torquability compared with other available guidewires but offer tremendous support at the tip, allowing maneuvers which are impossible with other wires on the market.

IntroductionBiliodigestive leaks are typically caused by an insufficiency at the surgical anastomosis. Biliodigestive anastomosis (BDA) insufficiencies can lead to bilomas, abscesses and vascular erosion in chronic conditions.Material and methodsWe performed a retrospective analysis of the medical and radiological records of all patients with biliodigestive insufficiency who received interventional treatment between July 2015 and February 2021. Nine patients (three with unilateral drainage and six with bilateral drainage) were treated with a modified percutaneous transhepatic cholangiodrainage (PTCD). Clinical success was considered after complete resolution of the peribiliary collections, absence of bile within the surgical drains, radiological patency of the BDA (contrast medium flowing properly through the BDA and no signs of leakage) and haemodynamic stability of the patient without signs of sepsis.ResultsClinical success was achieved in all nine patients. No patients required revision surgery to repair their BDA. The mean indwelling drainage time was 34.8±16.5 days. The mean number of interventional procedures performed per patient was 6.6±2.0.ConclusionPatients who present with BDA insufficiency may benefit from interventional radiological techniques. Our modified PTCD resolved the BDA leak in all nine cases and should be considered as a valuable option for the treatment of patients with this complication. Our technique demonstrated to be feasible and effective.

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm.Video 1

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