Abstract
We present two cases of acute cardioembolic occlusion of the middle cerebral arterial trunk with technical problems due to kinking of a Gateway^<TM> PTA dilatation catheter during local intraarterial fibrinolysis. Resistance was met when the guidewire was advanced and when the contrast medium was infused through the guidewire lumen during manipulation. Examination of the kinked catheters revealed multiple obstructions of the distal shaft developed during the procedure. The kinks seemed to be caused at the portion of the winding carotid siphon and/or the tip of the guiding catheter positioned in the tortuous internal carotid artery, especially without a guidewire. We conclude that careful manipulations of the Gateway^<TM> catheter is needed to avoid possible complications during local intraarterial fibrinolysis with an understanding of the characteristic features of the distal shaft, e.g. nonbladed, coaxial catheter.
