1. Crossing the Carotid Siphon: Techniques to Facilitate Distal Access in Tortuous Anatomy: 2-Dimensional Operative Video
- Author
-
Mark Bain, L. Nelson Hopkins, Eric Saugaveau, Peter Kan, J D Mocco, Rafael Rodriguez, Adnan H. Siddiqui, Caroline Hadley, Brian T. Jankowitz, Michael R. Levitt, Andrew J. Ringer, Jay U. Howington, Richard D. Fessler, William J. Mack, Mandy J. Binning, Robert E. Replogle, Rabih G. Tawk, Louis J. Kim, Alex Spiotta, Jan-Karl Burkhardt, Christopher S. Ogilvy, Babu G. Welch, Ali Sultan, Andrew W. Grande, Daniel Hoit, Adam S Arthur, Robert F. James, Ricardo A. Hanel, Demetrius K. Lopes, Howard A. Riina, Bernard Bendock, Elad I. Levy, Alex A Khalessi, David J. Langer, Alan S. Boulos, Raymond D Turner, Robert A. Mericle, Clemens M. Schirmer, Lee R. Guterman, Erol Veznedaroglu, Ajith J. Thomas, Aditya S. Pandey, Jeremiah N. Johnson, Giuseppe Lanzino, Jonathan White, and Webster Crowley
- Subjects
Adult ,Catheters ,business.industry ,Endovascular Procedures ,Anatomy ,Carotid siphon ,Tortuosity ,Treatment failure ,030218 nuclear medicine & medical imaging ,Anatomic variant ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Buddy wire ,medicine.artery ,medicine ,Humans ,Surgery ,Neurology (clinical) ,Internal carotid artery ,Endovascular treatment ,business ,Child ,030217 neurology & neurosurgery ,Carotid Artery, Internal - Abstract
As capabilities for endovascular treatment of intracranial vascular pathologies continue to expand, the need for access to the distal internal carotid artery with rigid support catheter systems continues to increase. One of the dominant factors limiting this access is patient anatomy, specifically vessel tortuosity. Increased tortuosity of the carotid siphon is a frequently encountered anatomic variant and may complicate endovascular procedures in adults and children.1,2 Failed attempts to navigate the carotid siphon with a distal access catheter carry a risk of vessel injury and treatment failure. For this reason, techniques that aid in supporting safe advancement of a distal access catheter across a tortuous carotid siphon are essential.3,4 In this video, we demonstrate 2 ways in which this may be accomplished. The first technique uses a larger diameter microcatheter, such as the AXS Offset catheter (Stryker, Kalamazoo, Michigan), to increase support for the distal access catheter, while the second uses a buddy wire technique to accomplish this increased support. Both of these techniques can help increase the safety of navigating a tortuous carotid siphon and increase the likelihood of successful treatment. The procedures shown were performed with the informed consent of the patients.
- Published
- 2020