Use of a Brachial Guidewire to Ease Internal Carotid Artery Stenting Via Femoral Approach in Challenging Anatomies

Carotid artery stenting has become a widely used treatment for carotid artery stenosis, whether symptomatic or asymptomatic. This procedure can be challenging in specific anatomies, especially when the vessels are tortuous or present an uncommon orientation. We describe a fully endovascular technique to mitigate the lack of support by using a stiff wire in the distal brachial artery to allow a safe catheterization of the brachiocephalic trunk with an 8F sheath. The procedure is then performed with a lower risk of backing out of the brachiocephalic trunk, thereby minimizing surgical risk.Clinical ImpactWe report a safe technical tip that eases catheterization of the brachiocephalic trunk in difficult anatomy, mitigating the lack of support encountered with a standard femoral approach and reducing the risk of kickback during maneuvers.