Turn-Over Technique Using a Balloon Guiding Catheter for Stable Transfemoral Neuroendovascular Therapy in Type III Aortic Arch with Severe Vessel Tortuosity.

OBJECTIVE

Endovascular treatment of cerebrovascular diseases can be challenging in patients with difficult access routes. We describe a turn-over technique using a balloon guiding catheter (BGC) via the transfemoral approach to perform neuroendovascular treatment.

CASE PRESENTATION

An 80-year-old female with a recurrent right middle cerebral artery (MCA) aneurysm after coil embolization underwent successful stent-assisted coiling via the transfemoral approach. The turn-over technique using a BGC proved effective for the difficult access route via the transfemoral approach. The guidewire and inner catheter were turned over above the aortic valve, and the BGC was advanced to the right subclavian artery. The guiding balloon was inflated, and the catheter shaft was pulled to release the loop on the aortic valve. Under roadmap guidance, the guidewire and inner catheter were advanced into the right internal carotid artery (ICA). After that, by using the balloon inflation anchoring technique, we carefully guided them to the right cervical ICA while preventing slippage.

CONCLUSION

The turn-over technique using a BGC via the transfemoral approach may offer a viable treatment option for patients with difficult vascular access.