ABSTRACT
This chapter summarizes the technical tips one might consider in carotid bifurcation angioplasty and stenting. A carotid and cerebral arteriogram should be performed as a separate procedure prior to the carotid stent. Patients with atherosclerotic ostial stenosis of the innominate, right common carotid and left common carotid arteries require angioplasty and stenting during carotid bifurcation intervention. Occasionally, the extent of proximal disease may preclude a safe carotid intervention. For patients with an occluded external carotid artery, sheath access to the common carotid may be difficult. A stiff guidewire can be placed into the distal common carotid artery, but maintained proximal to the lesion. A carotid angiogram is performed through the guiding sheath to further delineate the carotid bifurcation and the stenosis. The image intensifier is placed in an optimal position to separate the origins of the internal and external carotid arteries.
