Stenting the critical calyceal carotid bifurcation--a technical update

There are several anatomical appearances of the carotid bifurcation. A calyceal type of bifurcation, superimposed with distal angulation of the internal carotid artery (ICA) and added ICA stenosis can be extremely challenging with regard to placement of embolic protection devices, prolonging manipulation of the lesion, procedure time, increasing contrast use and thus increasing the risk of complications. Certain technical maneuvers can facilitate the procedure and minimize risk. This case study describes the steps taken to safely treat these lesions.