Innominate artery stenting

The figure shows a noncontrast fluoroscopic image following carotid and innominate angioplasty and stenting. The patient had a history of right carotid-subclavian artery bypass and subsequently developed high-grade stenoses of the common carotid and innominate arteries, impeding flow into the bypass. An embolic protection filter was placed into the distal carotid artery through the preexisting bypass via a right brachial approach (thin arrow), and femoral access was used to place a stiff wire through the lesion to perform the angioplasty and stenting (thick arrow).