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Figure 6: Distal radial “snuff box” approach for the right common and internal carotid artery stenting for 60% tandem stenosis in a symptomatic patient. (a) A roadmap after the transitional 5F dilator was placed and radial cocktail given (this is because we used a 80-cm 6F Infinity Plus 091 guide without a short sheath). (b) (Anteroposterior view) Roadmap of the common carotid artery details the sharp turn from the right brachiocephalic into the right common carotid artery (white arrow). (c) (Anteroposterior view) Right common carotid artery run, tandem common, and internal stenosis can be seen (white arrows), the contour of the Infinity guide from the right brachial to the right common carotid artery can be seen (white stars). (d) (Anteroposterior view) The Spider FX can be seen in the upper independent component analysis and again noted is the hairpin (white star) turn that the guide takes for stent delivery from the brachial artery to the right common carotid artery. (e) (Anteroposterior view) Balloon angioplasty with a 5-mm Euphora balloon post stenting can be seen (white arrow). (f) (Anteroposterior view) Poststenting and angioplasty right common carotid artery run reveal no residual stenosis and mild distal internal carotid artery spasm from the Spider FX distal embolic protection device (removed) (white arrow)

Figure 6: Distal radial “snuff box” approach for the right common and internal carotid artery stenting for 60% tandem stenosis in a symptomatic patient. (a) A roadmap after the transitional 5F dilator was placed and radial cocktail given (this is because we used a 80-cm 6F Infinity Plus 091 guide without a short sheath). (b) (Anteroposterior view) Roadmap of the common carotid artery details the sharp turn from the right brachiocephalic into the right common carotid artery (white arrow). (c) (Anteroposterior view) Right common carotid artery run, tandem common, and internal stenosis can be seen (white arrows), the contour of the Infinity guide from the right brachial to the right common carotid artery can be seen (white stars). (d) (Anteroposterior view) The Spider FX can be seen in the upper independent component analysis and again noted is the hairpin (white star) turn that the guide takes for stent delivery from the brachial artery to the right common carotid artery. (e) (Anteroposterior view) Balloon angioplasty with a 5-mm Euphora balloon post stenting can be seen (white arrow). (f) (Anteroposterior view) Poststenting and angioplasty right common carotid artery run reveal no residual stenosis and mild distal internal carotid artery spasm from the Spider FX distal embolic protection device (removed) (white arrow)