Catheterization of tortuous carotid arteries.

Not uncommonly, when cerebral angiography is performed via the femoral route , a long flexible-tip guide wire may be introduced into the appropriate vessel , but because of tortuosity of the carotid artery the catheter does not follow the guide wire. During attempts to maneuver the catheter into the carotid artery, the catheter and guide wire are displaced into the aortic arch . To overcome this, we introduce a long flexible-tip guide wire to a level just below the carotid bifurcation . An assistant compresses the carotid artery externally with the guide wire in situ. This helps " anchor" the guide wire while the catheter is threaded over it. The guide wire being held in position allows the passage of the catheter, and the whole assembly does not retract into the arch as it would without thi s maneuver. This maneuver should not be used in patients who have