{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T14:25:36Z","timestamp":1793543136289,"version":"4.5.0"},"reference-count":11,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2013,2,8]]},"published-print":{"date-parts":[[2014,3]]},"abstract":"\n Background and significance<\/jats:title>\n We describe a method by which to efficiently and atraumatically achieve distal positioning of a flexible guiding catheter beyond extreme cervical tortuosity using a hypercompliant temporary occlusion balloon.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective review of a prospective neuroendovascular database was used to identify cases in which a hypercompliant balloon catheter (Hyperform or Hyperglide, ev3\/Covidien, Irvine, California, USA; Scepter or Scepter XC, Alisa Viejo, California, USA) was used to achieve distal positioning of a flexible guiding catheter (Navion, ev3\/Covidien, Irvine, California, USA; Neuron, Penumbra Inc, Alameda, California, USA). After achieving a stable guiding sheath position within the proximal cervical carotid artery, a hypercompliant balloon catheter was manipulated beyond the tortuous cervical internal carotid segment into the distal carotid artery. The balloon was then inflated to anchor it distally within an intracranial (cavernous or petrous) segment of the internal carotid artery. The guiding catheter was then advanced beyond the tortuous cervical segment, over the balloon catheter, as gentle counter traction was applied to the balloon.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Balloon-assisted guiding catheter placement was used to perform endovascular treatments of 12 anterior circulation aneurysms. One patient underwent coiling alone. Five patients underwent balloon-assisted coiling. One patient underwent balloon and stent assisted coil embolization. Four patients with five carotid aneurysms (one with bilateral carotid aneurysms) underwent vascular reconstruction with the pipeline embolization device. All patients had severe tortuosity of the extracranial carotid system. Three patients had findings consistent with cervical carotid fibromuscular dysplasia. The technique was successful each time it was attempted. No parent artery dissections or catheter induced vasospam were noted in any case.<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Hypercompliant balloon catheters can be reliably used to facilitate safe and rapid distal positioning of flexible guiding catheters beyond severe cervical tortuosity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/neurintsurg-2013-010655","type":"journal-article","created":{"date-parts":[[2013,3,7]],"date-time":"2013-03-07T22:19:39Z","timestamp":1362694779000},"page":"129-133","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Balloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience"],"prefix":"10.1136","volume":"6","author":[{"given":"Lissa","family":"Peeling","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stony Brook University Medical Center, Cerebrovascular Center, Stony Brook, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fiorella","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stony Brook University Medical Center, Cerebrovascular Center, Stony Brook, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,3,7]]},"reference":[{"key":"2025092911282238000_6.2.129.1","doi-asserted-by":"crossref","first-page":"E616","DOI":"10.1227\/01.NEU.0000324918.46479.DD","article-title":"Intracranial placement of a new, compliant guide catheter: technical note","volume":"63","author":"Park","year":"2008","journal-title":"Neurosurgery"},{"key":"2025092911282238000_6.2.129.2","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.surneu.2009.03.016","article-title":"Distal intracranial catheterization of patients with tortuous vascular anatomy using a new hybrid guide catheter","volume":"72","author":"Simon","year":"2009","journal-title":"Surg Neurol"},{"key":"2025092911282238000_6.2.129.3","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1227\/01.NEU.0000185583.25420.DF","article-title":"Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients","volume":"57","author":"Cai","year":"2005","journal-title":"Neurosurgery"},{"key":"2025092911282238000_6.2.129.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-006-0157-1"},{"key":"2025092911282238000_6.2.129.5","first-page":"1502","article-title":"Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms","volume":"27","author":"Nii","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025092911282238000_6.2.129.6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.surneu.2006.03.044","article-title":"Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients","volume":"67","author":"Yuzawa","year":"2007","journal-title":"Surg Neurol"},{"key":"2025092911282238000_6.2.129.7","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318260fe86"},{"key":"2025092911282238000_6.2.129.8","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1136\/neurintsurg-2011-010041","article-title":"Utilization of the Neuron 6 French 0.053 inch inner luminal diameter guide catheter for treatment of cerebral vascular pathology: continued experience with ultra distal access into the cerebral vasculature","volume":"4","author":"Chaudhary","year":"2012","journal-title":"J Neurointerventional Surg"},{"key":"2025092911282238000_6.2.129.9","first-page":"1372","article-title":"Aneurysm rupture during GDC treatment: optimizing the rescue strategy","volume":"21","author":"Malisch","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025092911282238000_6.2.129.10","first-page":"275","article-title":"Stiff guide technique: technical report and illustrative case","volume":"24","author":"Eckard","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"2025092911282238000_6.2.129.11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1227\/NEU.0b013e3182315f22","article-title":"Merci retrievers as access adjuncts for reperfusion catheters: the grappling hook technique","volume":"70","author":"Hui","year":"2012","journal-title":"Neurosurgery"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2013-010655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T18:28:28Z","timestamp":1759170508000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2013-010655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,7]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2014,2,12]]},"published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1136\/neurintsurg-2013-010655"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2013-010655","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,7]]}}}