title: Complex carotid stenting using a coronary technique.
abstract: OBJECTIVE
  To report the utility of a coronary technique to facilitate carotid stenting in patients with difficult arch anatomies.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This anchoring technique can be a helpful method for cannulating the CCA in patients with a complex arch when the ECA is patent.
authors: Department of Interventional Cardiology, Tehran Heart Center, Medical Sciences/University of Tehran, Iran. Ekassaian@yahoo.com
authors: Seyed Ebrahim
authors: SE
authors: Kassaian
authors: Mohammad
authors: M
authors: Fotuhi
authors: Mehran
authors: M
authors: Mahmoodian
mesh_terms: D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000033:anatomy & histology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016893:Carotid Stenosis / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D006801:Humans; D015607:Stents