Crossing an Ultracritical Carotid Stenosis for Carotid Angioplasty

Carotid angioplasty requires early placement of a cerebral protection device in an effort to minimize cerebral embolization during the conduct of the subsequent angioplasty and stenting procedure. In patients who exhibit a very critical internal carotid artery (ICA) stenosis (∼99%), initial passage of the lesion may not be possible with a standard 0.014-inch wire system. In this report, the authors describe an approach using a 0.012-inch hydrophilic system to overcome this technical obstacle.