Double Wire Technique for Stenting Tortuous Cerebral Vessels

The failure to catheterize distal vessels may preclude optimal endovascular intervention. We present a double wire technique to facilitate the selective placement of catheters into tortuous vasculature when a single wire and catheter technique does not suffice. A wide necked middle cerebral artery (MCA) aneurysm incorporated the origin of the inferior MCA trunk, and despite successful passage of a wire into the distal MCA, the catheter could not be advanced beyond 2 sharp turns at the inferior trunk origin. A second wire was passed through the catheter into the inferior trunk providing adequate stability for advancement of the catheter into the vessel. The distal vessel was successfully catheterized and a stent was placed without complication. The double wire technique may allow the passage of catheters into vessels that are otherwise inaccessible because of tortuosity.