Use of a guide wire system to insert guiding catheters

Abstract

In patients with severe arteriosclerosis or anatomical variations such as a bovine arch, the insertion of a guiding catheter for carotid artery stenting is difficult. The authors use a guide wire system as an anchor and advance the guiding catheter to an area proximal to the stenotic structure. This method is useful and safer than others for carotid artery stenting.

Alternative method for accessing the target coronary artery in patients with difficult coronary anatomy: exchanging the diagnostic catheter with a guiding catheter

“…In previous literature, researchers have reported using similar methods for some neurovascular interventions. [6] In the neurovascular interventions, exchanging the diagnostic catheter with a guiding catheter seems relatively easy, since the target organ is stationary. The movement of the coronary arteries makes this exchange more challenging than those in the neurovascular interventions.…”

Transradial carotid stenting in a patient with bovine arch anatomy

“…PercuSurge GuardWireTM not only can be used as distal protection device during CAS, our case here established and extend the use of PercuSurge GuardWireTM as an anchor, to provide extra support during advancement of guiding catheter and exchange of guiding catheter. This method of advancing guiding catheter is useful and safer than others for carotid artery stenting [16].…”

Thrombectomy Using a Method to Directly Insert an Aspiration Catheter into a 6-Fr Sheath-introducer Placed into the Brachial Artery

“…If catheter insertion remains difficult, the catheter should be switched to one with a long tip (SY3 or SY6). In addition, the turn-over method, 4) in which a catheter is reversed at the aortic valve, a method to navigate a catheter by anchoring with a Guardwire system (Medtronic) that is advanced into the external carotid artery, 5) a method to stabilize a catheter using a Goose-neck snare catheter (Medtronic) inserted through the brachial artery, 6) and the balloon-inflation anchoring technique, 7) in which the balloon of a guiding catheter is effectively used, have been reported. On the other hand, if it is impossible to advance a guidewire, it should be switched to a Simmonstype guiding catheter (Neuro EBU 8-Fr; Gadelius Medical), or the parent and child balloon technique, in which a Guardwire system and guiding catheter's balloon are concertedly used, 8) should be adopted.…”

“…In case of bovine-type aortic arch, it may be possible to guide from the right brachial artery to the left CCA using an aspiration catheter alone by this method. However, if the left CCA originates from the aorta, as routinely observed, a catheter should be guided using various procedures through the femoral artery, 2,[4][5][6][7][8] or a Simmons-type guiding sheath should be used through the brachial artery. 13,14) Furthermore, direct puncture of the left CCA 11,16) may also be appropriate.…”

“…[1][2][3] When it is possible to navigate a guidewire to a carotid artery, carotid compression/ fixation of the guidewire 2) or switching to a stiffer guidewire facilitates treatment in many cases. However, when it is impossible to navigate a guidewire due to anatomical reasons for the aortic arch and the proximal segment of its branching vessels, more complex strategies are required, [4][5][6][7][8] or a change of the approaching site must be considered. [9][10][11] Under such circumstances, we switched the transfemoral artery approach to the transbrachial artery approach, and guided a catheter using a simple method to directly insert an aspiration catheter into a sheath-introducer (direct aspiration catheter technique [DACT]), facilitating thrombectomy in a relatively short time.…”