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【目的】経上腕動脈アプローチによる右頚動脈ステント留置術の際に右鎖骨下動脈subclavian artery; SAと総頚動脈common carotid artery; CCAの角度が強いと直接の誘導が難しいこの状況でCCA にガイドワイヤを容易に挿入する方法を紹介する【症例】71 歳男性黒内障で発見された右内頚動脈狭窄症で紹介された胸部大動脈瘤で弓部置換術後であったため経上腕アプローチで大動脈内操作を行わないステント留置術を計画した右SA と右CCA の角度が強く直接ガイドワイヤを進められなかったがピッグテールカテーテルの使用により容易に誘導できステント留置術を施行し得た【結論】上腕動脈経由の右CCA への直接誘導においてピッグテールカテーテルは有用であった Objective: We report a case of transbrachial right carotid artery stenting (CAS) without intra-aortic manipulation.Case presentation: A 71-year-old man presented with right visual field disturbance due to occlusion of the branch retinal artery and symptomatic right internal carotid artery stenosis. Because he had undergone aortic arch replacement for an aortic aneurysm, we planned CAS using the transbrachial approach without intra-aortic manipulation. During the guiding-sheath cannulation, it was difficult to insert a diagnostic catheter directly from the right subclavian artery to the right common carotid artery owing to the acute angle of these arteries. Using the pigtail catheter, the guidewire was easily inserted into the external carotid artery, and stenting was performed successfully.Conclusion: The pigtail catheter is an useful device for cannulating the guidewire through an acute-angled bifurcation

Guiding-sheath cannulation using a pigtail catheter for transbrachial carotid artery stenting without intra-aortic manipulation