Percutaneous transluminal angioplasty and stenting of the right internal carotid artery in recurrent stenosis– Vascular surgery

Puncture the right femoral artery in Seldinger technique at the groin and carefully introduce the guidewire. Remove the puncture cannula and introduce a 6F or 7F sheath under fluoroscopic guidance. Remove the guidewire and check the pulsatile return flow and then administer locally 5000 IU of heparin saline solution. Under fluoroscopic guidance, advance a long Terumo® guidewire through the right iliac axis into the aorta.

Tips:

1. Do not exert force when puncturing the femoral artery because of the risk of inguinal vascular dissection.

2.  If percutaneous puncture via both groins fails, make a mini-incision in one groin, expose the common femoral artery there and then puncture under direct vision. Access via puncture of the contralateral arm is possible, but probing will become much more difficult.

Angiography of the aortic arch reveals markedly dilated and elongated arteriosclerosis of the right internal carotid artery.

Tip:

We prefer the roadmapping technique so that we can work in the mask without the need for additional contrast media administration when probing the internal carotid artery.

Roadmapping („Pathfinder“):

This involves the administration of a small bolus of contrast agent to visualize the aortic arch as a roadmap. This image is saved as a mask. Subsequent images are then acquired without contrast media and subtracted from the mask. In this way, for example, only the current position of a radiopaque catheter will be displayed. In the resulting subtraction images, the bright catheter will be visible against the dark background of the aorta, and any background irrelevant to this study is omitted.

First, introduce the Terumo® guidewire into the brachiocephalic trunk and common carotid artery. Then advance an S-shaped guiding catheter over the Terumo® guidewire.

Tip:

In more severe elongation, park the Terumo® guidewire in the external carotid artery before advancing the guiding catheter into the common carotid artery. Otherwise, the Terumo® guidewire and guiding catheter will dislodge.