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Objective: Two cases in which right carotid artery stenting (CAS) was performed by navigating a 6 Fr guiding sheath through the transbrachial approach avoiding intraaortic arch manipulation are reported. Case Presentations: Case 1; A 72-year-old male with asymptomatic right carotid artery stenosis was scheduled to undergo stenting. Bilateral femoral artery stenosis and brachiocephalic artery stenosis were noted, and since the angle between the right subclavian and right common carotid arteries was steep, transbrachial CAS was performed without manipulations in the aortic arch using a 5 Fr Cerulean catheter with a tip shaped into a pigtail form. Case 2; A 66-year-old male was scheduled to undergo stenting for symptomatic right carotid artery stenosis. Thoracic aortic aneurysm and brachiocephalic artery stenosis were noted, and as the angle between the right subclavian and right common carotid arteries was steep, transbrachial stenting was performed without manipulations in the aortic arch using a 5 Fr Cerulean catheter with a tip shaped into a pigtail form. Conclusion: In direct navigation of a 6 Fr guiding sheath to the right common carotid artery for stenting by the transbrachial approach, a 5 Fr Cerulean catheter with a tip shaped into a pigtail form was useful.

Method to Navigate a Guiding Sheath Using an Intermediate Catheter without Intraaortic Manipulations in Transbrachial Right Carotid Artery Stenting