Carotid Stenting with Distal-Balloon Protection via the Transbrachial Approach

Abstract

Purpose: To document the feasibility of brachial artery access for carotid stenting with distal-balloon protection of the internal carotid artery (ICA). Technique: Via percutaneous access to the brachial artery, a large double-curve catheter is advanced into the aortic arch over a hydrophilic guidewire to cannulate the left common carotid artery. Following sheath exchange, a GuardWire distal-protection balloon is positioned within the left ICA distal to the stenosis. The lesion is dilated, followed by deployment and dilation of a self-expanding stent. Transcranial Doppler monitoring shows only scarce microembolic signals during the procedure. Conclusions: Carotid stenting with distal balloon protection via the brachial artery appears feasible as an alternative to standard femoral access.