Selection of Appropriate Inner Catheter for Placement of Guiding Catheter

Objective: Occasions to administer endovascular treatment to the elderly have increased, for which rapid and safe guiding catheter (GC) placement even in a lesion with seve re arteriosclerosis is required. We investigated an index to easily evaluate the degree of diffi culty before treatment. Methods: In all, 83 consecutive patients who received carotid artery stenting (CAS) through the transfemoral approach at our institution between May 2010 and December 2016 were divided into those in whom GC could be placed using the JB2-type inner catheter (IC) (JB2 group) and those who required the Simmon s type or Goose neck snare (SM/GS group). Vascular anatomy of the cervicothoracic region was evaluated and an index to select IC was investigated. Results: The JB2 and SM/GS groups consisted of 68 and 15 patients, respectively. The distributions of the following fi ve items were diff erent between the two groups: The level of the origin of the selected artery from the lesser curvature of t he aortic arch, aorta type, tortuosity of the common carotid artery, selected artery, and location of the lesion. On decision tree analysis of these factors, a fl owchart was prepared in which a lower level of the origin of the selected artery than the level of the lesser curvature of the aortic arch was the fi rst layer. Conclusion: IC selection can be more accurately evaluated based on whether the level of the origin of the selected artery is lower than the level of the lesser curvature of the aortic arch compared with evaluation of the aorta type III.