Morph Access of Celiac Artery
Dr. Stephen Kee
Associate Professor of Radiology
Dr. Joan Frisoli
Assistant Professor of Radiology
Stanford University Medical Center
Stanford, CA
Background
57 year old patient. 35+ year history of smoking. Multiple MI’s. Previously presented with SMA occlusion-unresolved. SMA/IMA totally occluded. Intestinal resection and celiac stenting 9 months prior. Celiac is final vessel supplying all flow to intestinal region and stent has now restenosed.
Procedure
Multiple attempts with a variety of catheters were made over 90+ minutes in an attempt to angioplasty a restenosed stent in the patient’s proximal Celiac artery (Figure 1). Various sheaths and catheters were used including 7F RDC1 introducer guide (Cordis), C2 Cobra catheter (Angiodynamics) and 5F Sos Omni catheter (Angiodynamics) with .035 Glidewire (BSX), .035 Stiff Glidewire (BSX), Rosen (Cook) and Bentson wires (Cook). Additional attempts with .014 wires, 4 Fr Glide Catheter (BSX),
RDC sheath (Cordis) and all previously listed wires also failed.
A 64 cm Morph Deflectable tip guiding catheter (BioCardia, Inc.) was then used to successfully canulate the Celiac artery (Figure 2). A 4F Glide catheter with an .035 Glidewire were advanced thru the occluded stent and exchanged for an .014 Transcend wire (BSX). A 7.0 mm X 2.0 cm Viatrac balloon (GDT) was then passed thru the occlusion resulting in successful angioplasty and a patent Celiac artery (Figure 3).
Outcome
Use of the Morph Deflectable Guide Catheter allowed easy access and provided sufficient support to advance a wire and balloon across this sharply inferior take-off Celiac artery. The case took less than 15 minutes to complete once the Morph was inserted and resulted in simplifying an otherwise very difficult procedure.
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