‘Railroad switch’ technique for stent-assisted coil embolization of a wide-neck bifurcation intracranial aneurysm: technical note

Abstract

Preservation of the posterior cerebral arteries during endovascular treatment of wide-neck basilar bifurcation aneurysms remains a technical challenge despite recent device innovations. We present a novel stent deployment technique, the ‘railroad switch’, to protect both posterior cerebral arteries during treatment of a recurrent basilar bifurcation aneurysm. Following asymmetric basilar–posterior cerebral artery stent deployment, favoring distal placement in a posterior cerebral artery, advancement of a jailed microcatheter will advance the proximal stent into the aneurysm, protecting both posterior cerebral arteries and the native basilar terminus. This novel maneuver offers interventionalists another application of commonly used intracranial stents for endovascular management of complex basilar bifurcation aneurysms.

Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent

“…26 In addition, we consider this new stent system as a perfect candidate for some alternative stenting techniques such as the 'Flow-T' setting or modified deployment manoeuvres such as the 'railroad switch'. 27,28 On the contrary, there is a certain concern regarding the new LVIS EVO stent observed in our series. Based on the discretion of the main operator and the fact that the new system comes with reduced nominal diameter and potentially lower radial force, each stent we used was slightly oversized with minimum 0.25 mm to the diameter of the target parent artery.…”