ABSTRACT
A 8 Fr sheath was placed into the right common femoral artery and 10 000 IU heparin given. Attempts to cannulate the left vertebral artery selectively with a 6 Fr multipurpose catheter were unsuccessful. A 6 Fr JR-4 diagnostic catheter successfully cannulated the left vertebral and a 0.035-inch exchange-length Wholey (Malinckrodt, St Louis, MO) wire was advanced across the lesion, taking care to avoid the V4 segment. The diagnostic catheter was exchanged for a 8 Fr multipurpose coronary guiding catheter over the Wholey wire. A 4 mm × 2 cm Opta-5 balloon was used to predilate the lesion at 6 atm. Next, a Palmaz P154 (Cordis, Miami, FL) stent was mounted on the predilatation balloon and deployed at the lesion site at 12 atm. Angiography demonstrated moderate residual stenosis, so a 5 mm × 2 cm Opti-5 (Cordis) balloon was inflated to 14 atm within the stent (Figure 5.1).
