title: Percutaneous superficial temporal artery access for carotid artery stenting in patients with a hostile aortic arch.
abstract: OBJECTIVE
  To describe an entirely percutaneous treatment for carotid artery stenting in a type IIa aortic arch via the superficial temporal artery (STA) for through-and-through guidewire access.
  
  
  METHODS
  The technique is demonstrated in an 83-year-old man status post left carotid endarterectomy 3 months prior who presented with 2.5 hours of confusion and dysphasia following diagnostic carotid arteriography. The patient was known to have a type IIa bovine aortic arch and a severe 70% stenosis of the left internal carotid artery. The patient was referred for carotid artery stenting by his vascular surgeon. Due to the bovine arch, a percutaneous ultrasound-guided approach via the STA for through-and-through wire access facilitated carotid artery stenting from the right common femoral artery. The procedure was successful, and follow-up duplex ultrasound confirmed patency of the STA the next day.
  
  
  CONCLUSIONS
  A percutaneous ultrasound-guided STA access can help facilitate transfemoral carotid artery stenting in an otherwise difficult type IIa aortic arch setting.
authors: Dayton Interventional Radiology, Dayton, Ohio 45409, USA. mubinsyed@aol.com
authors: Mubin I
authors: MI
authors: Syed
authors: Sukirtharin
authors: S
authors: Sinnathamby
authors: Azim
authors: A
authors: Shaikh
authors: Robert
authors: R
authors: Tyrrell
authors: Surender
authors: S
authors: Neravetla
authors: Kamal
authors: K
authors: Morar
mesh_terms: D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001027:Aortography; D001037:Aphasia / Q000209:etiology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D003221:Confusion / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D013699:Temporal Arteries / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional