case_images: PMC11380820_01
case_images: First session. (a) 5-F Sofia to C4-5 portion and Headway 27 to M1 (bold arrow). (b) Although the flow re-direction endoluminal device is being deployed from the middle of C2, the tip of the delivery wire tends to stray into the anterior choroidal artery (arrow). (c) The stent is not opening from C3 (arrows).
case_images: SNI-15-278-g001.jpg
case_images: PMC11380820_01_SNI-15-278-g001.jpg
case_images: F1
case_images: Deployment was started midway through C2, but the stent would not open from C3, and re-sheathing and re-placing it was attempted several times [Figure 1].
case_images: Second session. Intraoperative findings. (a) Working angle. (b) The FRED is not opening at all from the C3 section and is left within the Sofia (arrow). (c) After the FRED is released from the Sofia, the proximal end opens slightly (arrow). (d) As the CHIKAI 315 cm is used, the tip becomes J-shaped, and the true lumen can be secured (arrow). (e) Appropriate stent shortening and expanding when the wire secures the distal end of the stent. (f) The lumen of the stent is fixed using a Scepter. (g, h) Digital subtraction angiography after stent placement.
case_images: SNI-15-278-g002.jpg
case_images: PMC11380820_01_SNI-15-278-g002.jpg
case_images: F2
case_images: At this point, an exchange to a Scepter C (Microvention-Terumo) was performed, and the stent was fixed, which allowed stent placement in a good position [Figure 2].
case_images: The fluoroimages of the experiment. (a) The stent being difficult to open in the proximal part. (black arrows) (b) The proximal end being opened (white arrows) to be possible to capture the true lumen with the microwire (CHIKAI 315cm), which the tip smoothly becoming J shaped (bold black arrow) and (c) advancing inside the stent lumen (bold black arrow). (d) The stent twisting gradually released during the wire getting through (white arrows). (e) The fixing of the stent with balloon inflation and (f) after the deployment. The shortening of the stent being apparent in the proximal part not but the distal part, which resulted in successful placement in designated position without stent migration.
case_images: SNI-15-278-g003.jpg
case_images: PMC11380820_01_SNI-15-278-g003.jpg
case_images: F3
case_images: The stent was expanded and fixed using a Scepter C, as in the real procedure [Figure 3].