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J Mocco, Rabih G. Tawk, Babak S. Jahromi, Rodney M. Samuelson, Adnan H. Siddiqui, L. Nelson Hopkins and Elad I. Levy

mechanical intervention with microcatheter or microwire manipulation, snare devices, balloon angioplasty, intraarterial ultrasonography, and intracranial stent placement, have all been reported as alternative methods of revascularization associated with successful recanalization of occluded cerebral arteries. 3 , 12 , 17 , 20 There are data to support the suggestion that acute endovascular-mediated recanalization of thromboembolic cerebral vessel occlusion translates into improved clinical outcomes, even beyond 3 hours. 5 , 10 , 12–15 , 25 To evaluate further the

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Feng-Chi Chang, Ramachandra P. Tummala, Babak S. Jahromi, Rodney M. Samuelson, Adnan H. Siddiqui, Elad I. Levy and L. Nelson Hopkins

catheter resists the tendency to herniate back into the aortic arch as wires, balloons, embolic protection devices, or stent delivery systems are being advanced through it. F ig . 1 Schematic drawings illustrating reconstitution of the 8 Fr Simmons-2 catheter in the left subclavian artery. A: A stiff wire is advanced into the axillary artery to gain distal purchase. B: The catheter is advanced into the distal subclavian artery over the stiff wire. C: After the wire is removed, the catheter is slowly pulled back until the preshaped “knee” segment reaches the

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Paul T. L. Chiam, J Mocco, Rodney M. Samuelson, Adnan H. Siddiqui, L. Nelson Hopkins and Elad I. Levy

angioplasty) has been attempted. However, compared with a conventional procedure (angioplasty is performed followed by stenting during the same procedure) or a staged procedure (angioplasty is first performed followed by stenting ≥ 1 month later) direct stent placement appears to be associated with a higher complication rate because of emboli dislodged by the high profile of the stent delivery device and displacement of debris into the ostia of perforating vessels. 8 In addition, intracranial angioplasty and stenting have been associated with restenosis rates of up to 30