Usefulness of a Microcatheter with a Short and Acute Angled Tip Made from an Excelsior SL-10 Pre-shaped S Catheter Preserving Its Distal Curve

Abstract

A method to create a microcatheter with a short and acute-angled tip using an Excelsior SL-10 pre-shaped S catheter (Stryker, Kalamazoo, MI, USA) by straightening its proximal curve is described. Its clinical application, in which a guidewire and a microcatheter are led into a distal artery branching sharply to prepare stent deployment, is presented. Methods: The proximal curve of a catheter was introduced into a disposable 18-gauge blunt needle. The needle was heated using a heat gun so as to heat and straighten only the proximal curve and to preserve the original shape and firmness of the distal curve. The catheter was then used to lead a guidewire to a sharply branching distal artery and subsequently to navigate itself into the artery. In each case, the angle formed by the vector of the proximal parent artery and that of the distal artery was measured to evaluate the technical difficulty. The usefulness of the catheter was assessed by whether stenting was completed. Results: The microcatheter was used in 10 cases. The average angle between the distal artery and the proximal parent artery was 144°. In two cases where the angle was over 180°, the guidewire could not enter the orifice of the distal artery directly. The guidewire could directly enter the orifice of the distal branch in eight cases, with angles of 108°-151°. In seven of the eight, the guidewire and microcatheter could go further into the distal artery, and stenting was achieved. Conclusion: A short and acutely angled catheter tip made from an Excelsior SL-10 pre-shaped S catheter with preservation of the distal curve is stable in shape. It is often useful when leading a guidewire to an artery branching at a sharp angle to prepare for stent-assisted coiling.

Folded-Loop Guidewire Remodeling Technique: Catheterizing Markedly Angulated Branches during Intravascular Embolization

“…The acute angulation of branching vessel is one of the difficult situations to introduce into. To facilitate the laborious task, various methods have been introduced by many authors; using dual-lumen microcatheter with reverse wire ( 1 ); double-lumen microcatheter with side holes ( 2 ); balloon blocking technique ( 3 ); microcatheter looping technique ( 4 ); microcatheter pre-shaping technique ( 5 ); turn-back technique with a shaped microcatheter ( 6 ); catheter with a large side hole or cleft ( 7 ); shepherd’s hook technique ( 8 ).…”