title: [Stiffened triple axial catheterization of tortuous cervivoencephalic vessels].
abstract: Tortuous anatomy of the cervicoencephalic vessels can cause failure in 4 to 6% of interventional procedures by slippage of the material back in the aorta, kinking or difficulty to move forward a balloon. stent or microcatheter. We report on an old patient with high vascular tortuosity, referred for embolization of a ruptured aneurysm of the left inferior cerebellar artery. Access wasn't possible until we used a "triple axial system" with a long 7F sheath, positioned in the left subclavian artery and strongly supported by a super stiff guidewire with its distal end floating freely in the vascular lumen. Inside the sheath and parallel to the guidewire, we pushed a 4F catheter till the mid-vertebral artery. The microcatheter-microguide system tracked through it, towards the aneurysm, with the backward tendency being neutralized by the increased stiffness. Our technique presents the advantage of a strong back-up support, without increased risks such as vasospasm, clotting or dissection, since the guidewire serving as a stiff rail, lies exteriorly to the navigated vessel. Efficiency of this elegant and relatively low risk solution has yet to be proved in larger series.
authors.affiliation: Service d'lmagerie Médicale, Hôtel-Dieu de France, Beyrouth, Liban. sslaba@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Slaba
authors.forename: S
authors.initials: S
authors.lastname: Sfeir
authors.forename: J
authors.initials: J
authors.lastname: Nassar-Slaba
authors.forename: R
authors.initials: R
authors.lastname: Kikano
authors.forename: L
authors.initials: L
authors.lastname: Touma
authors.forename: J
authors.initials: J
authors.lastname: Tamraz
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography