Manual external carotid artery manipulation for failed device advance through the stent in carotid artery stent placement. A technical note.

We report herein the usefulness of a manual external carotid artery manipulation for failed advancement of devices through the stent in carotid artery stent (CAS) placement with open cell type stent and filter type distal protection device. In all, 22 consecutive patients underwent CAS with filter type protection device between April 2008 and December 2009 in our institution, and failed advancement of the devices through the stent occurred in 4 patients (18%). For all the 4 patients, the devices could be navigated normally through the stent under the manual external carotid artery manipulation. In cases with failed device advance in CAS, this maneuver would be one of the methods to resolve this.