Separation of left internal and external carotid arteries via right brachial artery approach in cerebral angiography

Cerebral angiography is essential for diagnosing cerebrovascular diseases and crucial to separate the internal and external carotid arteries during angiography. The femoral artery approach is more invasive than the brachial artery approach. In some cases, guiding the catheter through the right brachial artery to the left internal and external carotid arteries is feasible. This study retrospectively investigated factors influencing successful catheter guidance to the left carotid arteries. We studied 30 patients (17 men; mean age 64.9 years) in whom catheter guidance to the left internal and external carotid arteries was attempted via the right brachial artery. A 4Fr Simmons-type catheter and a 0.035-inch diameter guidewire were used. We retrospectively analyzed patient characteristics and aortic arch anatomy. Guidance was successful in 20 patients (66.7%). There were no significant differences in sex, age, height, weight, BMI, aorta type, or bifurcation type between the brachiocephalic and left common carotid arteries between the successful and unsuccessful cases. However, a significant difference was observed in the angle formed by the Simmons catheter during insertion into the left common carotid artery (45.7 degrees vs 19.3 degrees p < .01). The rising angles of the catheter entering the aortic arch from the brachiocephalic artery were 64.2 degrees versus 84.8 degrees, respectively (p < .01). Cut-off values were 30.9 degrees (AUC = 0.985) and 77.5 degrees (AUC = 0.9). Safe guidance to the left internal and external carotid arteries was achievable when the angle of the Simmons catheter curve was 30.9 degrees or greater and the rising angle of the catheter entering the aortic arch from the brachiocephalic artery was 77.5 degrees or less.