Double Wire Technique in Angioplasty with Stent for Symptomatic Middle Cerebral Artery Stenosis with Extremely Tortuous Access Vessel

Abstract

We present our initial experience with a double wire technique in the intracranial stenting of two patients with symptomatic middle cerebral artery stenosis associated with extreme tortuosity of the carotid siphon. In both of these patients the clinical picture was characterized by hemispheric transient ischemic attacks. Cerebral digital subtraction angiography revealed a high grade stenosis of the MCA main trunk (M1 segment) associated with extreme tortuosity of the ipsilateral internal carotid artery siphon. Initial attempts at endovascular stenting using standard techniques had failed. Both patients were eventually successfully treated with intracranial stent placement using a double wire technique. They had no complication during or after the procedure. There have been no ischemic events in either patient during a short-term follow-up. Our limited experience suggests the double wire technique is a safe and effective method to overcome a tortuous access vessel for intracranial stenting.