However tortuous, firm and patient engagement offers the best chance of curbing Pyongyang's nuclear ambitions and its missile program.
The suprarenal IVC segment of this patient was tortuous and elongated but remained intact (Fig. 2).
If severe dissection or elastic recoil occurred after angioplasty, the Apollo stent (for patients with less tortuous access) or the Wingspan stent (for patients with severe tortuous access or small target vessel) would be implanted.
Our results suggest that many incomplete colonoscopies can be completed with standard endoscopes, especially in patients with tortuous colons.
Botulinum toxin injection (BT) was offered as the therapeutic choice in achalasia patients with tortuous megaesophagus, epiphrenic diverticula, previous cardiomyotomy, age > 60 yrs with cardiopulmonary or comorbid diseases.
For patients with tortuous arterial access with a Mori A lesion, or small target vessel diameter <2.5 mm, direct angioplasty with Gateway balloon would be performed with submaximal dilation.
From our experience, the Gateway balloon catheter and Wingspan stent system is more suited to patients with tortuous vascular access, especially at the C4 segment, as this system has better flexibility in traversing curvatures.
These devices however proved to be too rigid for intracranial application in patients with tortuous supra-aortic and intracranial vasculature and resulted in relatively high rates of failed treatment attempts between 4 and 14%% [ 6].
For patients with tortuous arterial access and a Mori B or C lesion, or a lesion with a significant mismatch in the diameter between proximal and distal segment, angioplasty plus self-expanding stent (Gateway balloon plus Wingspan stent system) is preferred.
It is worth noting that the pattern of increasing vascularity in PsA synovial tissue has been shown to be markedly distinct from that observed in RA: PsA patients were shown to have predominantly tortuous, bushy vessels while RA patients had mainly straight, branching vessels [ 33].
