Background The off-label use of an extender wire during vertebral artery stenting and angioplasty with or with neuroprotection has not been previously reported.

Material and Methods Retrospective, single-patient, technical report.

Results After monorail balloon angioplasty was performed on a proximal left vertebral artery stenosis, the 190 cm long Accunet neuroprotection filter device was not long enough for delivery of an over-the-wire stent. After mating a 145 cm long, 0.014 inch extension wire to the filter device, a balloon-mounted Liberté stent was implanted with good angiographic and clinical results.

Conclusion The off-label use of an extender wire permits successful over-the-wire stenting on a monorail neuroprotection device for vertebral artery endosurgery.