Successful carotid artery stenting of a dissected, highly tortuous internal carotid artery after straightening with a peripheral microguidewire

•Stenting for tortuous internal carotid artery dissection is challenging.•The straightening with a peripheral microguidewire enabled use of carotid stents.•Stenting for tortuous dissection with a peripheral microguidewire is feasible. Endovascular reconstruction for carotid artery dissection (CAD) involving a highly tortuous segment of the cervical internal carotid artery (ICA) is challenging because the tortuous ICA may preclude navigation of large-profile carotid stents. Successful recanalization using low-profile neurostents has been reported in small case series only. We herein describe two patients with CAD of a tortuous segment who were successfully treated with large-profile carotid stents after straightening the ICA with a stiff peripheral microguidewire. In Case 1, a 33-year-old man presented with steno-occlusive left CAD involving coiling of the cervical ICA and left M2 occlusion. We could not navigate a carotid stent through the tortuous segment of the ICA using a standard neuro-guidewire. A carotid stent was successfully deployed after straightening the tortuous ICA with a peripheral guidewire, and subsequent thrombectomy using a large-bore aspiration catheter for the occluded M2 branch resulted in recanalization. In Case 2, a 64-year-old man presented with right steno-occlusive CAD involving kinking of the cervical ICA. We successfully deployed two carotid stents after straightening the tortuous ICA with a peripheral guidewire. Stenting after straightening with a peripheral microguidewire is feasible and may provide a therapeutic option for CAD in patients with a highly tortuous ICA.