{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:13Z","timestamp":1776096373306,"version":"3.50.1"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,23]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Neuroendovascular treatment for patients with large-volume residual false lumens in the dissected aorta is challenging. Here, the authors describe the \u201ctwining wire technique\u201d as a bailout in cases with failed navigation of a guidewire into the true lumen due to a dissecting aorta.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A man with a previous history of open surgical repair of the ascending aorta and aortic arch for type A dissection was transferred to the authors\u2019 hospital for recanalization of the occluded left middle cerebral artery (MCA). CT angiography showed a graft-repaired, deformed aortic arch with distally residual false lumen, narrowing the true lumen. During mechanical thrombectomy, a guidewire could not be navigated into the true lumen via transfemoral or transradial access due to the deformed aortic arch and distal residual false lumen. Another wire was therefore navigated transradially from the true lumen into the descending aorta by passing the narrowed segment of the aorta; the wire was used as a guide in the true lumen by twining both wires, achieving access to the true lumen via a transfemoral approach and recanalization of the occluded MCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The twining wire technique was useful to achieve access to the true lumen in a dissected aorta with a residual false lumen.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25993\">https:\/\/thejns.org\/doi\/10.3171\/CASE25993<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25993","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:03Z","timestamp":1775642643000},"source":"Crossref","is-referenced-by-count":0,"title":["Twining wire technique for an approach through the graft-repaired type A aortic dissection with residual false lumen for cerebral thrombectomy: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Kohei","family":"Chida","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University, Shiwa-gun"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryota","family":"Nozaki","sequence":"additional","affiliation":[{"name":"Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Shiwa-gun"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-936X","authenticated-orcid":true,"given":"Azuma","family":"Tabayashi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Iwate Medical University, Shiwa-gun, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8098-457X","authenticated-orcid":true,"given":"Ryo","family":"Itabashi","sequence":"additional","affiliation":[{"name":"Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Shiwa-gun"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8149-2988","authenticated-orcid":true,"given":"Yosuke","family":"Akamatsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iwate Medical University, Shiwa-gun"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Neurointervention","first-page":"64","article-title":"Pull-through buddy wire technique for endovascular thrombectomy in patients with acute ischemic stroke: technical note","volume":"16","author":"Chiang","year":"2021","unstructured":"Chiang PYLin YHHuang YCLee CW.Pull-through buddy wire technique for endovascular thrombectomy in patients with acute ischemic stroke: technical note. Neurointervention. 2021;16(1):64-69. doi:10.5469\/neuroint.2020.00409"},{"issue":"1","key":"bib2","series-title":"Eur J Cardiothorac Surg","first-page":"118","article-title":"Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status","volume":"49","author":"Weiss","year":"2016","unstructured":"Weiss GSanter DDumfarth JEvaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status. Eur J Cardiothorac Surg. 2016;49(1):118-124. doi:10.1093\/ejcts\/ezv044"},{"issue":"2","key":"bib3","series-title":"Interv Neuroradiol","first-page":"167","article-title":"A simplified pull-through angioplasty technique without a snare device. A technical note","volume":"19","author":"Matsumoto","year":"2013","unstructured":"Matsumoto YNakai KTsutsumi MA simplified pull-through angioplasty technique without a snare device. A technical note. Interv Neuroradiol. 2013;19(2):167-172. doi:10.1177\/159101991301900204"},{"issue":"1","key":"bib4","series-title":"J Neurointerv Surg","first-page":"17","article-title":"Endovascular thrombectomy in the setting of aortic dissection","volume":"9","author":"Reznik","year":"2017","unstructured":"Reznik MEEspinosa-Morales ADJumaa MAZaidi SDucruet AFJadhav AP.Endovascular thrombectomy in the setting of aortic dissection. J Neurointerv Surg. 2017;9(1):17-20. doi:10.1136\/neurintsurg-2016-012397"},{"key":"bib5","series-title":"World Neurosurg","first-page":"e344","article-title":"Left transradial neurointerventions using the 6-French Simmons guiding sheath: initial experiences with the interchange technique","volume":"152","author":"Ito","year":"2021","unstructured":"Ito HUchida MTakasuna HLeft transradial neurointerventions using the 6-French Simmons guiding sheath: initial experiences with the interchange technique. World Neurosurg. 2021;152:e344-e351. doi:10.1016\/j.wneu.2021.05.110"},{"key":"bib6","series-title":"Front Surg","article-title":"Direct carotid artery exposure for acute cerebral infarction in hybrid angiography suite: indications and limitations","volume":"8","author":"Chen","year":"2021","unstructured":"Chen CCChen CTWu YMDirect carotid artery exposure for acute cerebral infarction in hybrid angiography suite: indications and limitations. Front Surg. 2021;8:819053. doi:10.3389\/fsurg.2021.819053"},{"issue":"1","key":"bib7","series-title":"Stroke Vasc Neurol","first-page":"71","article-title":"Direct carotid puncture in acute ischaemic stroke intervention","volume":"5","author":"Colombo","year":"2020","unstructured":"Colombo ERinaldo LLanzino G.Direct carotid puncture in acute ischaemic stroke intervention. Stroke Vasc Neurol. 2020;5(1):71-79. doi:10.1136\/svn-2019-000260"},{"issue":"2","key":"bib8","series-title":"J Neurointerv Surg","first-page":"108","article-title":"Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations","volume":"7","author":"Mokin","year":"2015","unstructured":"Mokin MSnyder KVLevy EIHopkins LNSiddiqui AH.Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointerv Surg. 2015;7(2):108-113. doi:10.1136\/neurintsurg-2013-011007"},{"issue":"1","key":"bib1","series-title":"Neurointervention","first-page":"64","article-title":"Pull-through buddy wire technique for endovascular thrombectomy in patients with acute ischemic stroke: technical note","volume":"16","author":"Chiang","year":"2021","unstructured":"Chiang PYLin YHHuang YCLee CW.Pull-through buddy wire technique for endovascular thrombectomy in patients with acute ischemic stroke: technical note. Neurointervention. 2021;16(1):64-69. doi:10.5469\/neuroint.2020.00409"},{"issue":"1","key":"bib2","series-title":"Eur J Cardiothorac Surg","first-page":"118","article-title":"Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status","volume":"49","author":"Weiss","year":"2016","unstructured":"Weiss GSanter DDumfarth JEvaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status. Eur J Cardiothorac Surg. 2016;49(1):118-124. doi:10.1093\/ejcts\/ezv044"},{"issue":"2","key":"bib3","series-title":"Interv Neuroradiol","first-page":"167","article-title":"A simplified pull-through angioplasty technique without a snare device. A technical note","volume":"19","author":"Matsumoto","year":"2013","unstructured":"Matsumoto YNakai KTsutsumi MA simplified pull-through angioplasty technique without a snare device. A technical note. Interv Neuroradiol. 2013;19(2):167-172. doi:10.1177\/159101991301900204"},{"issue":"1","key":"bib4","series-title":"J Neurointerv Surg","first-page":"17","article-title":"Endovascular thrombectomy in the setting of aortic dissection","volume":"9","author":"Reznik","year":"2017","unstructured":"Reznik MEEspinosa-Morales ADJumaa MAZaidi SDucruet AFJadhav AP.Endovascular thrombectomy in the setting of aortic dissection. J Neurointerv Surg. 2017;9(1):17-20. doi:10.1136\/neurintsurg-2016-012397"},{"key":"bib5","series-title":"World Neurosurg","first-page":"e344","article-title":"Left transradial neurointerventions using the 6-French Simmons guiding sheath: initial experiences with the interchange technique","volume":"152","author":"Ito","year":"2021","unstructured":"Ito HUchida MTakasuna HLeft transradial neurointerventions using the 6-French Simmons guiding sheath: initial experiences with the interchange technique. World Neurosurg. 2021;152:e344-e351. doi:10.1016\/j.wneu.2021.05.110"},{"key":"bib6","series-title":"Front Surg","article-title":"Direct carotid artery exposure for acute cerebral infarction in hybrid angiography suite: indications and limitations","volume":"8","author":"Chen","year":"2021","unstructured":"Chen CCChen CTWu YMDirect carotid artery exposure for acute cerebral infarction in hybrid angiography suite: indications and limitations. Front Surg. 2021;8:819053. doi:10.3389\/fsurg.2021.819053"},{"issue":"1","key":"bib7","series-title":"Stroke Vasc Neurol","first-page":"71","article-title":"Direct carotid puncture in acute ischaemic stroke intervention","volume":"5","author":"Colombo","year":"2020","unstructured":"Colombo ERinaldo LLanzino G.Direct carotid puncture in acute ischaemic stroke intervention. Stroke Vasc Neurol. 2020;5(1):71-79. doi:10.1136\/svn-2019-000260"},{"issue":"2","key":"bib8","series-title":"J Neurointerv Surg","first-page":"108","article-title":"Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations","volume":"7","author":"Mokin","year":"2015","unstructured":"Mokin MSnyder KVLevy EIHopkins LNSiddiqui AH.Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations. J Neurointerv Surg. 2015;7(2):108-113. doi:10.1136\/neurintsurg-2013-011007"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25993.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25993.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25993.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:25:49Z","timestamp":1776093949000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/11\/12\/article-CASE25993.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,23]]},"references-count":16,"journal-issue":{"issue":"12"},"URL":"https:\/\/doi.org\/10.3171\/case25993","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,23]]}}}