Transradial Carotid Artery Stenting
With the telescopic technique, a long (125 cm) wire-braided Simmons 2 catheter (Cook, MN, USA) is positioned within the shuttle sheath and is used as the introducer. This technique is useful for sheath deployment in cases with extreme angles, such as nonbovine left carotid or sharp take-off of right CCA (Figure 8).
(Enlarge Image)
Figure 8.
Telescopic technique for left common carotid artery cannulation. (A) Simmons 2 catheter in left common carotid artery. (B) 5 Fr braided Simmons 2 (125 cm) catheter into 6 Fr Shuttle sheath. (C) Final result after transradial access carotid artery stenting of left internal carotid artery (Adapt 4–9/40 mm, Boston Scientific).
Insertion of the sheath or guiding catheter from TRA necessarily involves acute angles that must be negotiated. Different strategies for sheath deployment (direct cannulation, simple loop and deep loop retrograde cannulation) are related to the severity of the angle between the arm and CCA. In general, the different strategies vary according to the basic carotid artery classifications: right, bovine left and nonbovine left subgroups.
Telescopic Approach
With the telescopic technique, a long (125 cm) wire-braided Simmons 2 catheter (Cook, MN, USA) is positioned within the shuttle sheath and is used as the introducer. This technique is useful for sheath deployment in cases with extreme angles, such as nonbovine left carotid or sharp take-off of right CCA (Figure 8).
(Enlarge Image)
Figure 8.
Telescopic technique for left common carotid artery cannulation. (A) Simmons 2 catheter in left common carotid artery. (B) 5 Fr braided Simmons 2 (125 cm) catheter into 6 Fr Shuttle sheath. (C) Final result after transradial access carotid artery stenting of left internal carotid artery (Adapt 4–9/40 mm, Boston Scientific).
Insertion of the sheath or guiding catheter from TRA necessarily involves acute angles that must be negotiated. Different strategies for sheath deployment (direct cannulation, simple loop and deep loop retrograde cannulation) are related to the severity of the angle between the arm and CCA. In general, the different strategies vary according to the basic carotid artery classifications: right, bovine left and nonbovine left subgroups.