Brachial artery approach for transluminal angioplasty of the internal carotid artery

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Abstract
One possible problem in internal carotid angioplasty is inacessibility of the lesion due to elongation of the aortic arch, the brachiocephalic trunk, or the carotid artery itself. A new approach to performing angioplasty of the right or left internal carotid artery utilizing the brachial artery was used after failure of the transfemoral approach in 5 lesions (4 patients). The common carotid artery was cannulated with preformed 5F catheters. Angioplasty was performed with a conventional balloon dilatation catheter. If required, a Wall stent was implanted to optimize the angiographic result. After failure of the conventional transfemoral technique, the brachial technique permitted successful angioplasty of the ipsilateral internal carotid artery in 4 lesions and the contralateral internal carotid artery in 1 lesion. In 1 patient, a stent was implanted. No complications occurred. The mean stenosis diameter decreased from 77.8 ± 6.3% to 17.8 ± 9.1%. Doppler sonography performed 4–6 months later showed no restenosis. The brachial artery approach seems to be a suitable alternative to the femoral technique.

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