Double‐Wire Technique in Balloon‐Protected Carotid Artery Stenting

Abstract

The "double-wire technique" is safe and effective for the shortening of occlusion time during predilatation, stent implantation, and aspiration, leading to satisfactory technical and clinical outcomes, in most cases. This technique should be considered for balloon-protected CAS using the PercuSurge GuardWire.

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

“…In our experience, the multi-wire approach appears to be a safe, feasible, and relatively economical technique to overcome technical challenges caused by difficult neck anatomy during CAS. In contrast to other reports, 6,7 the first guidewire was not used to stabilize the guiding catheter but was passed directly into the ECA, as were the additional guidewires. This facilitates advancement of the guiding catheter and avoids the use of very stiff guidewires (e.g., Amplatz).…”

“…The use of different techniques and ad hoc catheters 5 has aided operators in overcoming anatomically hostile necks; however, the effectiveness of these maneuvers remains anecdotal. In this article, we present a specific technique, the so-called “multi-wire technique,” a modification of the double wire technique reported previously 6,7 to facilitate selective cannulation of common carotid arteries in patients with anatomically hostile necks.…”

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].…”

Endovascular Management of Extracranial Carotid Disease

“…This protection device should not be performed if the arteriogram demonstrates retrograde collateral flow from the ECA to the brain. Low operative morbidity and high technical success rates have been reported in clinical trials with such distal balloon protection devices (Kawarada et al 2007;Theron et al 1996;T€ ubler et al 2001). Technical difficulties with the use of the device result from having to pass a potentially friable atheromatous lesion prior to deploying distal protection and with the continuous flushing and aspiration required to clear the debris (Mathias and Gissler 2002; (Kawarada et al 2007).…”