Stenting of Vertebral Artery Origin with the Buddy Wire Technique in Tortuous Subclavian Artery

Uysal, Ender; Çalışkan, Can; Caymaz, İsmail; Orken, D N; Başak, Muzaffer

doi:10.1177/159101991001600209

Cited by 7 publications

(7 citation statements)

References 6 publications

(10 reference statements)

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“…There are various methods using a guidewire: the buddy wire technique and the stiff guide technique. 8 – 11) The buddy wire technique provides a stable platform in the subclavian artery for vertebral artery stenting in patients with tortuous vessels. This technique gives additional support to the stability of the guiding catheter.…”

Section: Discussionmentioning

confidence: 99%

“…For cases in which it is difficult to pass a device through a lesion, adjunctive techniques have been reported such as the buddy wire technique, the sheep technique, and the stiff guide technique. 8 – 13) In cases of a highly tortuous cervical internal carotid artery (ICA), it is often difficult to guide rigid devices such as carotid stents. We experienced a case of ICA dissection in which a stent was placed by straightening the highly tortuous vessel by the use of a proximal balloon.…”

Section: Introductionmentioning

confidence: 99%

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

Koide

Ito

Hino

et al. 2021

NMC Case Report Journal

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Koide

Ito

Hino

et al. 2021

NMC Case Report Journal

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“…This technique has been reported in neurointerventions for vertebral artery origin stenting, or coil embolization of posterior circulation aneurysms in patients with proximal vessel tortuosity. In these cases stability of the guiding catheter was achieved by adding a buddy-wire placed in the subclavian artery [13][14][15]. Some case reports have demonstrated the application of the buddy-wire technique during coiling of a wide-necked basilar tip aneurysm [16], to facilitate Y-stenting in a middle cerebral artery bifurcation aneurysm [17], navigation of a large microcatheter for treatment of ACOM aneurysm with a WEB device [18], or improving support during treatment of a dissecting cavernous ICA aneurysm [19].…”

Section: Discussionmentioning

confidence: 99%

When Two Is Better than One

et al. 2021

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Background Delivery of most flow diverters (FD) requires larger, and thus stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, also known as the buddy-wire technique, may be helpful for navigation and support in challenging situations. Methods We analyzed all flow diverter procedures in our prospectively collected database. We recorded all patient-related, anatomical and procedural information. We performed univariate statistics and technical descriptions. Results In total, 208 consecutive patients treated with a FD at our institution between July 2014 and August 2020 were retrospectively analyzed. In 17 patients the buddy-wire technique was used (mean age 63 years, range 31–87 years: 16 female). Aneurysms were located at the petrous, cavernous, supraophthalmic internal carotid artery, and a proximal M2 branch in 2, 7, 7 and 1 patient(s), respectively. In all cases a 0.027in. microcatheter was used for device deployment. In 14 patients with a wide-necked aneurysm the buddy-wire provided additional support to advance the microcatheter and mitigated the ledge between the aneurysm neck and the parent artery or a side branch. In two giant cavernous aneurysms treated with telescoping FDs, the buddy-wire was used to re-enter the proximal end of the foreshortened FD. Conclusion The buddy-wire is a useful technique in FD procedures to prevent herniation of the microcatheter into the aneurysm sack, in wide-necked aneurysms to mitigate the ledge effect between the aneurysm neck and the parent artery where the microcatheter tip may get stuck, or to enable re-entry into a foreshortened FD.

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“…Previous reports have described Stenting for Proximal VA Occlusion a variety of techniques used to obtain stability of the guide catheter. 6,8,12,15,18,19) The buddy wire technique is a well-known and rapid technique, 8) although this can provide unsatisfactory support for the guide catheter during passage beyond the occlusion. We selected the pull-up technique with a GooseNeck Snare as it provides stable support for the guide catheter and a smooth approach to the lesion.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

Nii¹,

Abe²,

Iko³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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An 87-year-old man presented with extracranial vertebral artery (VA) occlusion and progressive vertebrobasilar ischemia despite maximal medical management. Cerebral angiography showed left proximal VA occlusion, termination of the right VA at the ipsilateral posterior inferior cerebellar artery, and hypoplastic bilateral posterior communicating arteries. Although the stump of the left VA ostium was not visualized, the distal patent artery was reconstituted via muscular branches from the left subclavian artery (SCA). Endovascular angioplasty with a stent for left VA occlusion was performed. The nonvisualized VA ostium was extrapolated from the computed tomography angiography findings of the distal patent VA and the partial calcification of the SCA. The occluded VA was penetrated by the guide wire and revascularized by balloon angioplasty with the stent using the support of a snare wire inserted via the left brachial artery for stabilization of the guide catheter. This treatment resulted in resolution of the severe neurological findings.

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Stenting of Vertebral Artery Origin with the Buddy Wire Technique in Tortuous Subclavian Artery

Cited by 7 publications

References 6 publications

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

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

When Two Is Better than One

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

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