You could learn more about cardiology courses with Prof. Sameh Allam by clicking on the courses’ library link here:

Objectives for this course:
1- Master the essentials of a successful complex PCI by using the radial approach
2- Essential questions on radial approach and the use of the specific radial device(s)
3- Clinical case strategy and radial approach limits
4- Anatomical variations in the Radial artery.
5- Master the essential steps of a successful radial procedure.

The aortic arch is the section of the aorta between the ascending and descending aorta. As it arises from the ascending aorta, the arch runs slightly backward and to the left of the trachea. The distal segment of the aortic arch then traverses downwards at the fourth thoracic vertebra. From this point on, it continues as the descending aorta.

The aortic arch has 3 major branches. The brachiocephalic trunk is the first branch of the aortic arch and supplies blood to the right arm and right head and neck. The left common carotid artery is the second branch of the aortic arch, which supplies blood to the left side of the head of the neck. The last branch of the aortic arch is the left subclavian artery that distributes blood to the left arm.

The aortic arch is the segment of the aorta that helps distribute blood to the head and upper extremities via the brachiocephalic trunk, the left common carotid, and the left subclavian artery.

The aortic arch also plays a role in blood pressure homeostasis via baroreceptors found within the walls of the aortic arch. These receptors respond to stretching of the aortic wall and send a signal to the nucleus of the solitary tract in the brainstem via the vagus nerve, which can subsequently inhibit or disinhibit the sympathetic nervous system or activate the parasympathetic nervous system. This is one of the major mechanisms that helps prevent quick, drastic changes in blood pressure.

The aortic arch also has peripheral chemoreceptors known as aortic bodies that monitor blood composition, specifically the partial pressure of carbon monoxide and oxygen. Changes in either gas level will result in a signal being sent to the dorsal respiratory group in the brainstem via the vagus nerve, which will regulate breathing accordingly.

Selective Carotid Catheterization by Arch Type The selection of equipment for CAS is most dependent on the anatomy of the aortic arch and of the CCA proximal to the target lesion. A retrograde femoral artery approach to access the CCA is usually preferred, while a right brachial (or radial) access is required in complex arches or in cases where transfemoral access is not possible due to severe inflow occlusive disease. The choice of the technique to access the CCA is operator-dependent, though there are several anatomic factors that might favor one technique over another.

Their multiple configurations permit the choice of the most suitable catheter for the specific arch anatomy. Interventional sheaths, however, offer better wire-catheter support. Whichever technique is employed, careful placement of the tip of the guiding catheter or interventional sheath will help prevent spasm, thrombosis, or dissection. The tip is usually positioned in the distal CCA, while in cases requiring a more aggressive guiding catheter shape, the tip of the guide is usually positioned in the proximal segment of the CCA, although this generally provides less support for the procedure.

Conclusion The aortic arch markers should guide the operator for case selection and preplanning for carotid angioplasty and stenting. Unfavorable arch markers significantly encountered in the elderly represent potential hazards and causes for shower emboli in the process of gaining access, which can result in either contralateral or ipsilateral hemispheric strokes during the procedure. It seems imperative to have a thorough working knowledge of the arch anatomy, arch calcification, and arch vessel ostial stenosis, and how this can alter the risk of the procedure. Familiarization with the use of alternative approaches can minimize procedural risk.

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