ABSTRACT
This chapter provides a step-by-step approach to obtaining secure and adequate caliber access to be used as a conduit for intervention in the carotid artery. It discusses how to assess the anatomy, assemble supplies for access, place the access sheath, and troubleshoot the access. The segment of the arch in which the branch originates influences the level of difficulty encountered in selective catheterization of the carotid artery, and this feature plays a significant role in sheath placement. Success at sheath placement depends upon anatomy. Once the sheath is safely placed, the likelihood of success of the procedure is significantly enhanced. During selective catheterization of the arch branches, the maneuvers required are noted so that later intervention can be performed with this knowledge. Some arch anatomy or disease is severe enough that access is contraindicated due to the risk of arterial injury or embolization.
