Twining wire technique for an approach through the graft-repaired type A aortic dissection with residual false lumen for cerebral thrombectomy: illustrative case.

BACKGROUND: Neuroendovascular treatment for patients with large-volume residual false lumens in the dissected aorta is challenging. Here, the authors describe the "twining wire technique" as a bailout in cases with failed navigation of a guidewire into the true lumen due to a dissecting aorta.

OBSERVATIONS: 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' 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.

LESSONS: The twining wire technique was useful to achieve access to the true lumen in a dissected aorta with a residual false lumen. https://thejns.org/doi/10.3171/CASE25993.