Carotid Artery Angioplasty and Stenting in Patients With Hostile Anatomy:The Multi-Wire Technique

Abstract

The multi-wire techniques appear to be a safe and effective method to aid cannulation and angioplasty of carotid arteries in patients with hostile neck anatomy.

Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting

“…Cardaioli et al. 17 proposed the “multi-wire technique” to facilitate selective cannulation of the common carotid artery in patients with anatomically hostile necks. Given the inherent limitation of embolic protection devices with the unprotected steps of arch, supra-aortic, and lesion navigation, especially for patients with a complex aortic arch anatomy, a technique for cerebral protection with flow reversal using the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Inc., Sunnyvale, CA, USA) was reported by Criado et al.…”

“…Montorsi et al 15 and Fang et al 16 described carotid angioplasty and/or CAS using a catheter looping and retrograde engagement technique via the brachial or radial approach in patients with a bovine aortic arch configuration. Cardaioli et al 17 proposed the "multi-wire technique" to facilitate selective cannulation of the common carotid artery in patients with anatomically hostile necks. Given the inherent limitation of embolic protection devices with the unprotected steps of arch, supra-aortic, and lesion navigation, especially for patients with a complex aortic arch anatomy, a technique for cerebral protection with flow reversal using the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Inc., Sunnyvale, CA, USA) was reported by Criado et al 18 and evaluated by Alpaslan et al 19 In the PROOF study, 75 patients who underwent transcarotid artery revascularization with the ENROUTE System were evaluated.…”

An anchoring technique by looping with the tip of a super-stiff wire: may be a solution in patients with anomaly of the aortic arch and tortuous carotid artery disease?

“…Cardaioli et al 8 have described a technique to place a double or triple 0.035 hydrophilic wire in ECA as another alternative way called the multiwire technique. Since it is a different technique, we did not cannulate the CCA using the usual methods in our case with a tortuous CA and unfavourable aortic arch.…”

Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience

“…When we experienced difficulty in advancing the coaxial system over the hydrophilic guidewire, the diagnostic catheter (4 or 5F) was initially advanced into the distal CCA target over the hydrophilic guidewire: this allowed the guiding catheter (7 or 8F) to slowly advance into the CCA target over the diagnostic catheter (with a Terumo wire inside). Other alternative techniques for stable cannulation of the CCA in hostile vascular anatomy have been proposed: a direct CCA cutdown with local anaesthesia (Choi et al, [30]), the 'external carotid artery stiff wire technique' (Montorsi et al, [28]), the 'buddy wire technique' [40][41][42], the 'multi-wire technique' (Cardaioli et al, [26]), a homemade modified (pierced) guiding catheter with a manually created hole close to the tip allowing the passage of a second guidewire (Coppi et al, [35]), the 'coronary technique' (Solomon et al, [38]), and recently a transradial or transbrachial arterial approach using the 'catheter looping and retrograde engagement technique' (Fang et al, [39]). …”

“…Different techniques are used to facilitate cannulation, angioplasty and stenting of ICA in patients with hostile vascular anatomy [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”