Complex Carotid Stenting Using a Coronary Technique

Abstract

Purpose:

To report the utility of a coronary technique to facilitate carotid stenting in patients with difficult arch anatomies.

Technique:

When confronted with challenging arch anatomy that prevents engaging the common carotid artery (CCA) with the guiding sheath using standard techniques, an 8-F left Amplatz guiding catheter (AL1) is placed at the origin of the innominate artery. A 0.014-inch coronary guidewire is advanced into the external carotid artery (ECA), and a small monorail coronary balloon is inflated in a small branch of the ECA. The balloon/guidewire combination facilitates maneuvering a 0.035-inch Amplatz super-stiff guidewire through the ECA and then advancing the guiding catheter into the CCA.

Conclusion:

This anchoring technique can be a helpful method for cannulating the CCA in patients with a complex arch when the ECA is patent.