Initial experience with a multiple parallel guidewire support system for complex tortuous aortic arch navigation and great vessel catheterization: technical note

Abstract

<jats:p>The ability to traverse an anatomically challenging and complex arch is paramount to the success of any neuroendovascular procedure. With age, the aortic arch becomes elongated, calcified, and less compliant. The authors present the initial experience with a multiple parallel guidewire system (ZigiWire Mode 3) for catheterization through a complex tortuous aortic arch to access extracranial vessels. The ZigiWire is an organized guidewire system that uses consecutive delivery of 3 small-diameter (0.014-inch) guidewires that are progressively advanced in parallel to secure support-wire access. The authors have found it useful in situations in which traditional methods for great-vessel access have failed. Moreover, the progressive construction of a large wire from smaller wires prevents “kickback” force from a single larger guidewire, allowing stable distal access. The authors have been able to advance different diagnostic and guide catheters over the ZigiWire. This guidewire has allowed them to successfully complete neuroendovascular procedures in patients who were previously considered unsuitable for the procedure because of tortuous vascular access.</jats:p>

Unfavorable Vascular Anatomy during Endovascular Treatment of Stroke: Challenges and Bailout Strategies

“…When this is not feasible, the use of multiple parallel guidewires is another alternative. 27 With this technique, we engage the supra-aortic vessel of interest with the diagnostic catheter to individually advance 2 to 3 micro-guidewires (0.014" or 0.018") as distal as possible into the CCA, ECA, or ICA. After all guidewires are in place, the diagnostic catheter is advanced into the distal cervical vessel of interest and we finally advance the guiding catheter into the target cervical vessel ( Figure 5).…”

“…When this is not feasible, the use of multiple parallel guidewires is another alternative [ 27 ]. With this technique, we engage the supra-aortic vessel of interest with the diagnostic catheter to individually advance 2 to 3 micro-guidewires (0.014” or 0.018”) as distal as possible into the CCA, ECA, or ICA.…”