¤TECHNICAL NOTE ¤ Percutaneous Superficial Temporal Artery Access for Carotid Artery Stenting in Patients With a Hostile Aortic Arch Mubin I. Syed, MD 1,2 ; Sukirtharin Sinnathamby, MD 3 ; Azim Shaikh, MD, MBA 1 ; Robert Tyrrell, MD 1 ; Surender Neravetla, MD 4 ; and Kamal Morar, MD 1 1 Dayton Interventional Radiology, Dayton, Ohio, USA. 2 Wright State University, Department of Radiological Sciences, Dayton, Ohio, USA. 3 Good Samaritan Hospital, Department of Interventional Cardiology, Dayton, Ohio, USA. 4 Springfield Regional Medical Center, Department of Cardiothoracic Surgery, Springfield, Ohio, USA. ¤ ¤ Purpose: To describe an entirely percutaneous treatment for carotid artery stenting in a type IIa aortic arch via the superficial temporal artery (STA) for through-and-through guidewire access. Technique: The technique is demonstrated in an 83-year-old man status post left carotid endarterectomy 3 months prior who presented with 2.5 hours of confusion and dysphasia following diagnostic carotid arteriography. The patient was known to have a type IIa bovine aortic arch and a severe 70% stenosis of the left internal carotid artery. The patient was referred for carotid artery stenting by his vascular surgeon. Due to the bovine arch, a percutaneous ultrasound-guided approach via the STA for through-and-through wire access facilitated carotid artery stenting from the right common femoral artery. The procedure was successful, and follow-up duplex ultrasound confirmed patency of the STA the next day. Conclusion: A percutaneous ultrasound-guided STA access can help facilitate transfemoral carotid artery stenting in an otherwise difficult type IIa aortic arch setting. J Endovasc Ther. 2011;18:729–733 Key words: superficial temporal artery, through and through access, type IIa bovine aortic arch, carotid artery stent, ultrasound guidance ¤ ¤ Carotid artery stenting (CAS) is a well-known procedure to treat restenosis following carotid endarterectomy (CEA). 1,2 Technical difficulties arise often in the elderly population due to arch vessel tortuosity and aortic arch elonga- tion and distortion. Stenting in this situation often results in complications, such as dis- lodgment of the entire delivery system from the target vessel during the procedure or failure to catheterize with large-caliber sheaths despite numerous attempts. The superficial temporal artery (STA) has been previously used as an additional access for a through- and-through guidewire to facilitate CAS in challenging situations. 3–6 Access to the STA has been obtained with a surgical cutdown in the past, but we describe an entirely percuta- neous, ultrasound-guided approach to the STA to facilitate transfemoral CAS. TECHNIQUE The technique is demonstrated in an 83-year- old symptomatic (occasional episodes of The authors have no commercial, proprietary, or financial interest in any products or companies described in this article. Corresponding author: Mubin I. Syed, MD, FSIR, FACR, Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409 USA. E-mail: mubinsyed@aol.com J ENDOVASC THER 2011;18:729–733 729 ß 2011 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS Available at www.jevt.org