Selecting Aortic Arch Vessels - Angled Catheter

The organization of aortic arch vessels and the arch anatomy varies among patients. Some are easier to catheterize and some are very difficult. In this video we have chosen a relatively straight-forward arch to show how to navigate and select vessels off the aortic arch: innominate artery, left common carotid artery and left subclavian artery. In femoral cerebral angiography using an angled catheter, catheterization of aortic arch vessels is done from proximal-to-distal. Turn the tip towards head and keep it that way while slowly pulling the catheter back. While puffing contrast and pulling back the catheter with tip facing up, watch for a “click”, and then puff stronger to see outline of the innominate artery. Next vessel off the aortic arch is the left common carotid artery. To catheterize, keep the catheter tip up and while puffing contrast slowly pull the catheter. The last aortic arch vessel to catheterize is the left subclavian artery: After left internal carotid artery angiogram, pull back the catheter tip into the origin of left common carotid artery. While puffing contrast and keeping catheter tip up, gently pull back the catheter and watch for another “click”…. Then do a stronger contrast puff… #education #training #cerebral #angiogram #angiography #cerebral_angiogram #fellow #interventional #interventional_neuroradiology #neurology #surgical_neuroangiography #neuroendovascular_surgery #neurointervention #interventional_neurology #endovascular_neurosurgery #femoral_angiogram