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Intracranial interventions comprise a set of procedures, which are complex and challenging. Further, they are extremely risky because complications in the brain are usually associated with significant mortality and morbidity. Thus, a clear understanding is necessary to handle tortuous vessels because improper planning can result in a higher rate of complications. The combination of long sheaths, specialty wires, and preshaped catheters can enable us to access some of the most complex vascular anatomy. There are several conditions that can contribute to a difficult access. There are few techniques described by different authors. The authors have listed the techniques found useful based on their experience. These challenges include tortuous iliac arteries, dilated tortuous aortic arch, acute takeoff of the arch vessels, tortuous neck vessels with prominent loops, crossing a large aneurysm, extensive peripheral vascular disease, etc.

Overcoming Tortuous Anatomy in Intracranial Intervention