ABSTRACT
This chapter aims to update the technique and results of endovascular management ofinnominate and common carotid artery occlusive lesions. Although common carotid and innominate artery lesions are much less common than carotid bifurcation lesions, endovascular management is more widely accepted for the following reasons: Arch branch lesions are less accessible surgically; these lesions are less likely to present with embolization; and data has accumulated over a period of time about the results of this approach. The common carotid artery is exposed through a short supraclavicular incision, either transverse or longitudinal. A retrograde carotid arteriogram is performed through the sidearm of the sheath. Completion arteriography is performed through the retrograde sheath or through the transfemorally placed flush catheter. The carotid artery may be backbled and flushed through the arteriotomy after sheath removal. Balloon angioplasty and stent placement has been used with success for innominate and common carotid artery lesions and reported in several single institution series.
