Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis:  A Technical Note

Tomoki KOIDE; Yoshiro ITO; Tenyu HINO; Masayuki SATO; Aiki MARUSHIMA; Mikito HAYAKAWA; Yuji MATSUMARU; Eiichi ISHIKAWA

doi:10.2176/nmccrj.tn.2020-0343

Technical Note

Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note

Tomoki KOIDE, Yoshiro ITO, Tenyu HINO, Masayuki SATO, Aiki MARUSHIMA, Mikito HAYAKAWA, Yuji MATSUMARU, Eiichi ISHIKAWA

Author information

Tomoki KOIDE
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Yoshiro ITO
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Tenyu HINO
Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
Masayuki SATO
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Aiki MARUSHIMA
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Mikito HAYAKAWA
Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
Yuji MATSUMARU
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
Eiichi ISHIKAWA
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

Keywords: carotid artery stenting, dissection, tortuous, proximal balloon guiding, buddy wire technique

JOURNAL OPEN ACCESS FULL-TEXT HTML

2021 Volume 8 Issue 1 Pages 387-391

DOI https://doi.org/10.2176/nmccrj.tn.2020-0343

Details

Abstract

In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the “snake hunt technique” because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.

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