A case of carotid stenting via the transbrachial approach in the bovine arch

We report our experience in carotid stenting via the transbrachial approach in patients with anomalous origin of the left common carotid artery, the so-called bovine arch, in which both the right common carotid artery and the left common carotid artery arise from the brachiocephalic artery. Via percutaneous access to the right brachial artery, a 6Fr Shuttle sheath is advanced into the aortic arch to cannulate the left common carotid artery. A Guardwire distal-protection balloon is positioned within the left internal carotid artery distal to the stenosis. The lesion is dilated, followed by satisfactory deployment and dilation of a 6Fr Precise stent. Carotid stenting via the brachial artery in bovine arch appears feasible as an alternative to standard femoral access.