The sheeping technique or how to avoid exchange maneuvers

Abstract

The sheeping technique may improve safety by replacing the need for an exchange maneuver during difficult balloon- or stent-assisted coiling.

Balloon-assisted microcatheter navigation for AVM embolization: technical note

“…19 The struggling microcatheter navigation usually requires multiple attempts and excessive wire exchanges, leading to distal wire perforation in more than 3% of cases 2 and death in up to 4.6% of patients. 4 Consequently, AVMs with such angioarchitecture are frequently managed with embolization of the superficial feeders, with the patients being subsequently referred to stereotactic radiosurgery for treatment of the deep supply. 15,17 Compliant balloons have joined routine practice in neurointerventional procedures.…”

Retrograde access to the posterior inferior cerebellar artery in balloon-assisted coiling of posterior inferior cerebellar artery aneurysms

“…Using the sheeping technique,7 it was then possible to navigate with the balloon catheter alongside the microcatheter in the ipsilateral vertebral artery in order to reach the PICA (figure 3D, E).…”

Flow diversion in challenging vascular anatomies: the use of low profile stent retrievers for safe and accurate positioning of the microcatheter

“…However, the delivery of the extra-saccular endovascular implants to sometimes quite peripherally located vascular targets may prove particularly challenging, especially when encountering significant proximal supra-aortic elongation along with unfavorable distal junction angles at the transition from the proximal to the distal segments of the cerebral vessels (Schob et al, 2019a;Martínez-Galdámez et al, 2019). In those cases, exchange maneuvers are required to eventually provide a sufficiently large lumen for device delivery in combination with stable access to the target segment (Chapot et al, 2013). Conventionally, those exchange maneuvers are performed under greatest precaution using a long 300 cm measuring exchange wire, which allowsto a limited extentcontrolled maintenance of the distal endovascular position whilst extra-corporeally substituting the first, smaller microcatheter for the second, larger microcatheter.…”

“…Conventionally, those exchange maneuvers are performed under greatest precaution using a long 300 cm measuring exchange wire, which allowsto a limited extentcontrolled maintenance of the distal endovascular position whilst extra-corporeally substituting the first, smaller microcatheter for the second, larger microcatheter. The microcatheter substitution along the exchange wire involves a significant risk for vascular injury, distal wire perforation and subsequent SAH (Chapot et al, 2013). An additional, certainly less critical but rather frequently encountered complication is the loss of distal endovascular access during the exchange maneuver, as the propulsive motion of the second microcatheter eventually causes unintended retraction of the distally placed wire, or the microwire simply does not provide adequate mechanical support to advance the large bore microcatheter to its desired final position.…”

“…Subsequently, as the currently available small lumen is insufficient for delivery of the FD, a long, stiff exchange wire providing enhanced mechanical support is inserted and positioned distally. Then, the most critical step, removal of the smaller microcatheter and introduction of the required microcatheter is performed, trying to maintain an atraumatic distal wire position (Chapot et al, 2013). After the large-bore microcatheter is eventually positioned properly, implantation of the FDS can be performed.…”