Buddy Catheter Technique: A Method of Guiding the Mo.Ma Ultra into a Left Common Carotid Artery That Branches off the Aortic Arch at a Steep Angle

Abstract

Objective The Mo.Ma Ultra is an embolic protection device used in carotid artery stenting (CAS). In cases of left internal carotid artery stenosis (ICS) in which the common carotid artery (CCA) branches off the aortic arch at a steep angle, insertion of the Mo.Ma Ultra into the CCA is sometimes difficult. We introduce a “buddy catheter technique” that helps guide the Mo.Ma Ultra into the CCA, with an additional 4 Fr catheter into the external carotid artery. Case Presentation An 84-year-old man with left ICS whose CCA also branched off the aortic arch at a steep angle also underwent CAS. The “buddy catheter technique” was used, and the Mo.Ma Ultra was inserted smoothly. The buddy catheter technique displaces the left CCA upward. Displacement straightens the vessels anatomically, and the ledge effect can be prevented by aligning the course of the vessels with the wire. Nevertheless, this technique requires bilateral femoral puncture, and so, complications can occur. Conclusion The buddy catheter technique may be considered in cases in which the left CCA branches off the aortic arch at a steep angle.

Mid‐term efficacy of castor stent and in situ fenestration stent in the treatment of type B aortic dissection involving the left subclavian artery: A retrospective single‐center study

“…Conversely, CSs allow for aortic arch adjustments, and most angles between the LSA and the aortic arch can be accommodated, thereby increasing the applicability of the technique and enhancing surgical success rates. In some patients with a steep aortic arch, the ISFs technique has certain limitations, particularly the insufficient anchorage distance of the main stent graft 23 . Insufficient anchorage distance necessitates moving the main stent graft forward, potentially covering or partially covering the left common carotid artery, which may affect its flow 24 .…”

“…In some patients with a steep aortic arch, the ISFs technique has certain limitations, particularly the insufficient anchorage distance of the main stent graft. 23 Insufficient anchorage distance necessitates moving the main stent graft forward, potentially covering or partially covering the left common carotid artery, which may affect its flow. 24 Notably, CSs have a variety of models, and an appropriate stent type can be chosen according to the morphology of the LSA and aortic arch, greatly increasing adaptability and surgical success rates.…”