Small Balloon Bridge: Improved Technique for Reaccessing Carotid Artery Stent

Abstract

Background: 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.

Case description: 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.

Conclusions: 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.

Keywords: Angle; Carotid artery stent; Complication; Guiding catheter; Reaccess; Small balloon bridge.