title: Modified technique for using vascular sheaths in carotid artery stent placement.
abstract: OBJECTIVE
  To report a technical modification that will prevent sheath kinking in acutely angled vessels during carotid stent placement.
  
  
  METHODS
  If a long vascular sheath kinks when engaging an acutely angled common carotid or innominate artery, the sheath is pulled caudally approximately 2 cm while a 0.014-inch guidewire, supported by a coronary balloon catheter, is advanced toward the internal carotid artery (ICA). Alternatively, to avoid kinking, the original 0.035-inch super stiff wire is maintained within the sheath until the 0.014-inch wire and coronary balloon have exited the sheath's distal tip.
  
  
  CONCLUSIONS
  If an aortic arch is tortuous and the angle of the common carotid artery is unfavorable, a guiding catheter is preferable to a long vascular sheath for accessing the ICA during carotid stent procedures.
authors.affiliation: Department of Radiology, University of Texas Health Science Center at San Antonio, 78284, USA. wholey@uthscsa.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Wholey
authors.forename: B
authors.initials: B
authors.lastname: Toursarkissian
authors.forename: S
authors.initials: S
authors.lastname: Bailey
mesh_terms: D001013:Aorta, Thoracic; D002340:Carotid Artery Diseases / Q000628:therapy*; D017536:Carotid Artery, Common; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D004868:Equipment Failure; D006801:Humans; D015607:Stents