Endovascular treatment for atherosclerotic stenosis within V3 segment of a hypoplastic vertebral artery Case report

Introduction: The endovascular treatment of intracranial atherosclerotic stenosis has become a common intervention. However, few reports are available regarding stenting performed for hypoplastic vertebral artery (HVA) with multiple atherosclerotic lesions. Combining multiple neuroendovascular devices provides more possibilities for technical success. We describe a stenting technique using a distal intracranial catheter (Navien) for providing an approach to an HVA with multiple existing atherosclerotic lesions. The technique involves a coaxial system comprising a 6F 70-cm long sheath and 5F 115-cm Navien catheter, which provides a stable support and a shorter distance for the navigation of a balloon-mounted stent. Thus, a stent can be easily delivered avoiding any obstacles such as curves or tortuosity in the VA without distal advancement of the microwire. Conclusion: The procedure was completed successfully with neither arterial perforation nor injury of the vessel wall. To the best of our knowledge, this is the first study that has reported the use of a Navien catheter in an HVA as an adjunctive technique for the delivery of an Apollo intracranial stent. The combination of the Apollo stent and Navien catheter is an alternative technique that may improve the safety of intracranial stenting procedure.