Modified technique for using vascular sheaths in carotid artery stent placement

Purpose: To report a technical modification that will prevent sheath kinking in acutely angled vessels during carotid stent placement. Technique: If a long vascular sheath kinks when engaging an acutely angled common carotid or innominate artery, the sheath is pulled caudally approximately 2 cm while a 0.014-inch guidewire, supported by a coronary balloon catheter, is advanced toward the internal carotid artery (ICA). Alternatively, to avoid kinking, the original 0.035-inch super stiff wire is maintained within the sheath until the 0.014-inch wire and coronary balloon have exited the sheath's distal tip. Conclusions: If an aortic arch is tortuous and the angle of the common carotid artery is unfavorable, a guiding catheter is preferable to a long vascular sheath for accessing the ICA during carotid stent procedures.