"Squirt-pull" technique for left carotid catheterization.

Using the Seldinger technique in a percutaneous femoral approach, a 7 French sidewinder femorocerebral catheter is advanced over a movable-core safety J guide wire [2] to the aortic arch , where catheterization of the left carotid is attempted initially by the conventional open-loop method with withdrawal hooking of the arterial orifice . When difficulty is encountered , the following technique can be used : The catheter tip is placed midway between the innominate artery and the left common carotid artery (fig. 1 A, position 1) or midway between the left subclavian artery and the left common carotid artery (fig . 1 B, position 1). Under fluoroscopic guidance, about 7 ml of contrast material is injected rapidly by means of a 10 ml syringe. The force of injection causes the catheter tip to be medially deflec ted (fig 1 , position 2) . The deflected catheter tip approaches the opening of the left common carotid artery, allowing the