Catheter modification for easier cannulation of the carotid artery during angioplasty and stenting

To present a modification of both the guiding catheter and stent delivery system to facilitate access into sharply curved supra-aortic vessels during carotid angioplasty.

Access failures during carotid interventions typically occur because either the vessel origin is acutely angled or the stenosis is located proximal to the carotid bifurcation, limiting access to the external carotid artery. We directly catheterized the left common carotid artery or brachiocephalic trunk with a guiding catheter whose tip had been curved by steam-shaping. The tip of the stent delivery system also was molded into a curve by this process so it engaged the curved part of the guiding catheter without pulling it out of the vessel.

This simple modification can improve the success rate of carotid cannulation via the femoral approach and does not seem to increase the risk of the intervention.