Ohshima Tomotaka, Miyachi Shigeru
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2020 Aug 28;15(3):753-755. doi: 10.4103/ajns.AJNS_238_20. eCollection 2020 Jul-Sep.
Navigating a large-caliber catheter into the intracranial artery may generate a "ledge effect," which disturbs successful neurointervention. Particularly, navigation of a large-lumen aspiration catheter is often required to achieve fast recanalization in acute ischemic stroke cases. Occasionally, the aspirator cannot be passed through the ophthalmic artery origin because of the ledge effect. Here, we report a new technique for mitigation of the ledge effect that involves the use of double micro-guidewires (MGWs). We refer to this technique as the "beanstalk method." We evaluated the efficacy of our idea using a silicon vascular model. Two 0.014" MGWs are used for navigation of a 0.068" aspirator. After one guidewire is navigated to the distal portion, another MGW is advanced along with the former guidewire, in a spiral fashion, similar to the growth of a beanstalk. The aspirator can then pass with the coaxial double-guidewire, although there is a severe gap in the vessel. We performed an study to demonstrate the effectiveness of the beanstalk method. The beanstalk method was very useful, even under challenging conditions that did not allow for passage of a conventional coaxial catheter or buddy-wire. The beanstalk method effectively decreases the ledge effect because of the shape of the two wires just ahead of the catheter, which contrasts with the hardness of the spiral wires. In cases involving challenging vasculature, the beanstalk method achieves smoother catheter navigation than the conventional coaxial method or buddy-wire technique.
将大口径导管插入颅内动脉可能会产生“边缘效应”，这会干扰神经介入手术的成功进行。特别是在急性缺血性中风病例中，常常需要使用大腔吸引导管来实现快速再通。有时，由于边缘效应，吸引器无法通过眼动脉起始处。在此，我们报告一种减轻边缘效应的新技术，该技术涉及使用双微导丝（MGW）。我们将此技术称为“豆茎法”。我们使用硅血管模型评估了我们想法的有效性。两根0.014英寸的微导丝用于引导0.068英寸的吸引器。一根导丝引导至远端部分后，另一根微导丝与前一根导丝一起呈螺旋状推进，类似于豆茎的生长。然后，尽管血管存在严重间隙，吸引器仍可与同轴双导丝一起通过。我们进行了一项研究以证明豆茎法的有效性。即使在不允许传统同轴导管或伙伴导丝通过的具有挑战性的条件下，豆茎法也非常有用。由于导管前方两根导丝的形状与螺旋状导丝的硬度形成对比，豆茎法有效地降低了边缘效应。在涉及具有挑战性的血管系统的病例中，豆茎法比传统同轴法或伙伴导丝技术能实现更顺畅的导管插入。
