Two-wire (0.014 & 0.018-inch) technique to facilitate innominate artery stenting under embolic protection

Purpose: To describe a 2-wire technique for innominate artery stent placement under embolic protection. Technique: Confronted with a high-grade innominate artery stenosis that blocked passage of a 0.035-inch stent delivery system from the femoral approach, a 0.018-inch guidewire was advanced in retrograde fashion via the right radial artery and captured via the femoral approach, establishing right radial-femoral through-and-through access. The 0.018-inch guidewire provided excellent support for positioning an 8-F hydrophilic sheath at the origin of the innominate artery. A 0.035-inch catheter was used to cross the lesion from the femoral approach, and a 0.014-inch buddy wire was introduced into the right common carotid artery. A 7-mm SpideRX filter was then deployed over the 0.014-inch guidewire. The 2-wire combination was used to load a 0.035-inch-compatible balloon-expandable stent system, which was deployed in the innominate artery and flared proximally, with excellent angiographic result. Conclusion: This technique provided excellent support in difficult anatomy while enabling use of a 0.035-inch-compatible stent and embolic protection. It has also been applied in the subclavian artery with protection of the vertebral or internal mammary artery and for lower extremity interventions.