Transbrachial-carotid artery stenting by direct puncture of brachial artery through a small skin incision

Objective : We herein report a successful case of carotid artery stenting (CAS) with direct puncture of brachial artery through a small skin incision. Case presentation : An 80-year-old male presented with left hemianopsia. Brain MRI showed acute cerebral infarcts in the watershed territory between the middle cerebral artery and posterior cerebral artery, and MRA revealed severe stenosis of the right internal carotid artery (ICA) with unstable high-volume plaque. A balloon guide catheter was required advancing a microguide wire through the stenotic lesion; however, the use of the transfemoral route was thought to carry a high risk due to the presence of aneurysms in the thoracic aorta, abdominal aorta, and/or iliac artery associated with severe atherosclerotic changes. Therefore, we performed direct puncture of the right brachial artery through a small skin incision followed by the insertion of a 9-French guiding catheter. Stenting was then successfully performed under double protection without any complication. Conclusion : This novel approach is considered to be effective for treating transfemoral CAS in cases requiring a proximal protection device. changes.