Technique of Carotid Artery Stenting for Cases with a Difficult Access Route

Abstract

This paper focuses on cases with difficult access for carotid artery stenting (CAS), and discusses management of such cases.
Of 135 consecutive patients who underwent CAS from January 2012 to December 2015 in our department, 11 (5.2%) had a difficult access route. In 3 cases with stenosis or elongation of the iliac arteries, we selected a smaller guiding sheath to pass through the artery. In one case with elongation of the abdominal aorta, a long and kink-resistant sheath was used to perform CAS. In 7 cases with a difficult femoral approach, CAS was performed via the right brachial artery. All 11 CAS procedures were uneventful without any perioperative complications.
Even in cases with a difficult access route, CAS can be performed safely with several techniques as described in this article.