Micro-Balloon Anchoring Technique: A Universal Solution for Navigational Difficulties of Straight-Shaped Balloon Guide Catheters in Carotid Artery Stenting

BACKGROUND: Complex aortic arch anatomies, such as type III or bovine arches, often hinder balloon guide catheter (BGC) navigation during carotid artery stenting (CAS). To address this issue, we devised the micro-balloon anchoring technique (MBAT), which ensures reliable BGC advancement even in challenging vascular anatomy. METHODS: MBAT was applied in 16 of 58 CAS procedures performed between October 2023 and February 2025 at Kobayashi Neurosurgical Hospital. These cases were retrospectively analyzed according to a predefined institutional strategy. In MBAT, a micro-balloon is inflated in a branch of the external carotid artery to provide distal anchoring, facilitating stable advancement of a long-neck Simmons catheter and BGC. Right distal radial access was prioritized. Procedural outcomes and complications were evaluated. RESULTS: MBAT enabled successful BGC navigation in all 16 cases (100%), including 14 with type III arch and 2 with bovine arch. Facial or lingual artery anchoring was most commonly used. No periprocedural strokes, dissections, or access-site complications occurred. CONCLUSION: MBAT is a safe and effective technique for guiding BGCs into target vessels during CAS, particularly in anatomically challenging cases. It can be performed using widely available devices and enhances procedural success by improving catheter trackability. MBAT represents a practical adjunctive technique for neuroendovascular specialists managing complex access routes.