title: Modification of a Braided Support Catheter into a Rapid Exchange System for Navigation of a Distal Protection Device through Significant Vascular Tortuosity.
abstract: Cerebral embolic protection devices (EPD) reduce the rate of periprocedural thromboembolic complications and are currently used in all carotid artery stenting (CAS) procedures. However, tortuous vascular anatomy of the internal carotid artery (ICA) may prevent navigation of distal EPDs, thereby leading to inadequate cerebral protection. We present a case in which significant tortuosity of the ICA distal to the stenotic lesion precluded navigation of currently available distal EPDs. During a CAS procedure, significant vascular tortuosity of the distal cervical ICA was noted which prevented navigation of currently available distal EPDs due to catheter kinking. In order to overcome this anatomic barrier, a novel rapid exchange catheter system (RECS) was created using a modified DAC 038 braided catheter through which a distal EPD and microguidewire were placed. This newly devised RECS allowed navigation of the distal EPD past the tortuous ICA bend and successful completion of the CAS procedure without periprocedural complications. We demonstrate that modification of currently available devices can, in select cases, effectively address cases of significant vascular tortuosity which limit the use of conventional distal EPDs.
authors.affiliation: Department of Neurological Surgery, University of Virginia; Charlottesville, VA, United States - dmd7q@hscmail.mcc.virginia.edu.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Neurological Surgery, University of Virginia; Charlottesville, VA, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Radiology, University of Virginia; Charlottesville, VA, United States.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Durst
authors.affiliation: Department of Radiology, University of Virginia; Charlottesville, VA, United States.
authors.forename: Avery J
authors.initials: AJ
authors.lastname: Evans
mesh_terms: D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000601:surgery; D002405:Catheterization, Central Venous / Q000379:methods*; D057785:Catheters; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000209:etiology; D018810:Magnetic Resonance Angiography; D013923:Thromboembolism / Q000517:prevention & control
keywords: carotid artery stenting; carotid stenosis; embolic protection device; endovascular procedures; rapid exchange catheter