Small Balloon Bridge: Improved Technique for Reaccessing Carotid Artery Stent.

Abstract

This is new research about the technology for navigating a catheter that is eccentric or tangentially angled to the long axis of a carotid artery stent. In our clinical practice, we found resistance when the 8-French guiding catheter crossed the balloon, even when it was partially expanded. Therefore we intended to improve the operating procedure by using a smaller balloon with a diameter of 2 mm. The smaller balloon can navigate the guiding catheter to reaccess the angled junction with minimal resistance after it is fully expanded. We applied the small balloon bridge technology in 1 case of left internal carotid artery stent implantation. After the stents were released successfully, we found that it was difficult to recapture an umbrella because the guiding catheter had a steep angle to the long axis of carotid artery with released stents. To overcome this obstacle, we sent a 2-mm balloon into the tip of the catheter and then inflated it fully. Therefore the steep angle could be straightened due to the expanded balloon playing a supportive effect. As a result, the guiding catheter reaccessed the previous angled junction smoothly as the small balloon moved forward and recaptured the umbrella successfully. Using the small balloon bridge technique to navigate the guiding catheter is a safer, simpler, and more effective operation for carotid interventional therapy. Furthermore, it might also be applied to other endovascular treatments that require guiding catheters for intervention.