Modified technique for using vascular sheaths in carotid artery stent placement.
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.
Wholey
M H
MH
Department of Radiology, University of Texas Health Science Center at San Antonio, 78284, USA. wholey@uthscsa.edu
Toursarkissian
B
B
Bailey
S
S
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