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Case series
Wire escalation in emergent revascularization procedures of internal carotid artery occlusions: the use of high tip stiffness microguidewires
  1. José E Cohen1,2,
  2. Ronen R Leker3,
  3. John M Gomori2,
  4. Eyal Itshayek1
  1. 1Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  2. 2Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  3. 3Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  1. Correspondence to Professor J E Cohen, Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel; jcohenns{at}


Objective We examined the usefulness and safety of high tip stiffness cardiac microguidewires in the endovascular revascularization of selected cases of internal carotid artery (ICA) occlusion.

Methods Files of patients with acute ischemic symptoms due to ICA occlusions managed from August 2010 to August 2016 by urgent endovascular revascularization were retrospectively reviewed with a waiver of informed consent. Cases where there was escalation to stiff tipped cardiovascular microguidewires after at least two failed attempts to cross the carotid occlusion with standard neuro-microguidewires were included. Radiological and interventional data were recorded.

Results 63 patients with acute carotid occlusions underwent emergent endovascular revascularization in the study period; 5/63 patients met the inclusion criteria. In 4/5 patients, there was no angiographic evidence of the remnant origin of the ICA; in 1/5 there was a wide round shaped proximal calcified cap that precluded soft guidewire entry. In all cases, antegrade wiring was achieved only after switching to stiffer guidewires designed for the management of chronic cardiac occlusions. The use of these stiffer tip wires was considered of critical importance in achieving the successful performance of the ICA revascularization procedure. In all patients, revascularization was achieved, and 90 day modified Rankin Scale score ranged from 0 to 2.

Conclusions When regular neuro-guidewires do not allow antegrade wiring in cases of ICA occlusion, wire escalation to high tip stiffness guidewires may improve success. These wires, designed to deal with chronic total coronary occlusions, can serve as a platform for new neuro-guidewires to be used in the challenging field of resistant supra-aortic occlusions.

  • guidewire
  • Stent
  • Stroke
  • Technique
  • Angioplasty

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  • Contributors JEC treated the patients presented in the study, designed the study, gathered and analyzed the data, drafted and critically revised the manuscript, and reviewed the final version of the paper. RRL and JMG treated the patients, contributed to manuscript preparation and review, and reviewed the final version of the paper. EI contributed to manuscript preparation and review, and reviewed the final version of the paper.

  • Competing interests None declared.

  • Ethics approval The study was approved by the institutional review board of the Hadassah-Hebrew University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Individuals interested in access to additional details should contact the corresponding author.