• David Rafael Santiago-Dieppa, Jeffrey A Steinberg, Michael G Brandel, Robert C Rennert, Vincent J Cheung, Arvin Raj Wali, Scott Eric Olson, Alexander Arash Khalessi, and J Scott Pannell.
• Department of Neurological Surgery, University of California, San Diego, California, USA.
• World Neurosurg. 2018 May 1; 113: 257-260.

BackgroundCrossing a nascently deployed carotid artery stent (CAS) is required to perform angioplasty and filter recapture. If the traversing balloon or filter recapture catheters are eccentric or tangentially angled to the vertical axis of the CAS, they can ensnare on the ledge of the proximal CAS step-off, potentially causing life-threatening complications secondary to deformation, displacement, or mechanical occlusion of the stent. We report a novel "balloon bridge" technique that facilitates safe entry and passage across the CAS with both a balloon catheter and a large-bore guide catheter (LBGC).MethodsWe used the balloon bridge technique for 2 patients with >90% carotid artery stenosis and steep carotid artery angles of origin who underwent routine CAS, balloon angioplasty, and distal embolic protection. During filter recapture, the balloon was inflated across the junction of the distal LBGC tip and proximal CAS, centering the LBGC within the vessel lumen and CAS. During balloon deflation, the LBGC was sequentially advanced, successfully navigating the LBGC across the proximal stent construct without resistance or complication.ResultsThe balloon bridge technique was completed without complications. We believe that the mechanism of action is secondary to balloon-facilitated LBGC alignment with the true axis of the stent.ConclusionsTraversing a CAS with an LBGC or balloon catheter can be tedious and fraught with the potential of neurologic peril should mechanical deformation and occlusion occur. The balloon bridge technique is safe and highly effective for navigating a catheter that is eccentric or tangentially angled to the long axis of a CAS.Copyright © 2018 Elsevier Inc. All rights reserved.

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