Establishing stable innominate access by inserting a body floss wire from the brachial artery to the femoral artery facilitates right carotid artery stenting in Type III arch anatomy

OBJECTIVES: In patients with severe carotid artery stenosis, the anatomy of their Type III aortic arch increases the difficulty and complication rates during carotid artery stenting because of its tortuosity and sharp angulation for cannulation as well as the unstable support of the guidewire for shuttle sheath delivery. METHODS: We demonstrate a novel technique to overcome these challenges, namely the creation of stable innominate artery access by inserting a through-and-through body floss wire from the right brachial artery to the femoral artery. RESULTS: We successfully performed right carotid artery stenting in 3 patients with Type III arch anatomy. All patients received regular outpatient follow-up uneventfully for more than 1 year. CONCLUSIONS: This facilitates the procedure of the right carotid artery stenting in patients with Type III aortic arch.