Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion.

Stroke is the fifth leading cause of death in the United States and is one of the leading causes of patient disability. Treatments for intracranial intravascular damage as a result of stroke have evolved extensively over recent decades, as management has become increasingly innovative. Various prospective studies and years of data have refined the current guidelines for treatment of acute ischemic stroke (AIS) and also reflect on the novel interventions for stroke management. Nonetheless, AIS remains a difficult and multifactorial etiology of disease to treat. As physicians adapt evidence-based knowledge to their interventional management of patients with AIS, the accompanied use of intravascular devices, such as steerable microcatheters, reduces radiation and procedure time. Considering all of the applications for steerable microcatheters, the use of these devices for AIS interventions may be most necessary.

A Novel Nonvascular Application of the Steerable Microcatheter.

The percutaneous nephrostomy (PCN) is a relatively common interventional procedure used to treat a multitude of nephro-urological conditions. Traditionally, interventional radiologists use ultrasound guidance, needles, catheters, and guidewires to access the collecting system percutaneously. The placement of a nephro-ureterostomy stent may be precluded by challenging renal calyx anatomy or an underlying disease process that obstructs placement. In cases of complex obstruction, accessing the renal collecting system may require deviation from conventional methods. We present a case that after many failed attempts with a wide variety of guidewires and catheters, a steerable microcatheter (SMC) was used to safely and effectively access the renal collecting system. This novel technique utilizes the SMC to efficiently achieve complicated PCN stent placement, relieving the renal drainage system obstruction and potentially minimizing or avoiding complications, such as urosepsis and/or renal failure.

Welcome to the New Era: A Completely Wireless Interventional Procedure.

The number of minimally invasive interventional radiology (IR) and interventional cardiology vascular procedures performed increases every year. As the number of vascular procedures increases, the need for advanced technology and innovative devices increases as well. Traditionally, as a general rule, a catheter is used in conjunction with a guidewire in such procedures. The underlying principle of IR is to always use a guidewire prior to any advancement of a catheter. This article describes a revolutionary theory that utilizes a new technology and contradicts this basic principle. Using a steerable microcatheter, a bilateral uterine artery embolization was performed from a wrist access with no guidewire. Furthermore, this technique reduced the procedure time by more than half when compared to standard of care. This technique may be applicable to other IR procedures, which could potentially reduce the time critically ill patients spend in the procedure area outside the intensive care unit.

Larger Sizes Matter More! Applying the Matteo Mathematics Method for Endovascular Aortic Bifurcation Reconstruction to Large Venous Vascular Repair.

Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is a well-established option with mortality benefits compared to conventional surgical management. The same theory, formulas, and techniques can be applied to the central venous system as long as there are commercially available devices. Using mathematically derived criteria for optimal stent size selection, endovascular aortic bifurcation reconstruction with kissing stents was extrapolated to the inferior vena cava (IVC). This report describes a traumatic case of IVC injury that was successfully repaired using the standard aortic grafts while adhering to the guidelines for proper stent size selection.

Against the Odds: A Novel Technique to Perform Cholangiography from a Percutaneous Approach through the Cystic Duct.

Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis. PTC may be difficult in a patient with minimal biliary tree dilatation, or tortuous cystic duct anatomy. In cases such as these, a steerable microcatheter (SMC) may be utilized to enable or expedite PTC. The technique to traverse and catheterize the cystic duct and opacify the gallbladder, bile ducts, and duodenum utilizing an SMC is described. This report outlines a non-vascular application of the SMC resulting in a successful cholangiogram, with reduced operative time and thus reduced radiation exposure to the patient.

Minimally invasive treatments for venous compression syndromes.

The management of venous compression syndromes has historically been reliant on surgical treatment when conservative measures fail. There are, however, several settings in which endovascular therapy can play a significant role as an adjunct or even a replacement to more invasive surgical methods. We explore the role of minimally invasive treatment options for three of the most well-studied venous compression syndromes. The clinical aspects and pathophysiology of Paget-Schroetter syndrome (PSS), nutcracker syndrome, and May-Thurner syndrome are discussed in detail, with particular emphasis on the role that interventionalists can play in minimally invasive treatment.