FIG 4. A and B, Illustration of the buddy catheter technique in a 70-year-old man.

A, Left, Left carotid angiogram shows near occlusion of the ICA. The 90° takeoff angulation made advancement of the GuardWire temporary occlusion catheter into the stenotic ICA impossible. Right, Angiogram shows the buddy catheter (5F, 125-cm JR4, arrow) positioned through a 6F guiding sheath, with its tip pointing into the angulated ICA lesion. The temporary occlusion catheter is advanced through the stenosis into the distal segment of the ICA.

B, Left, Angiogram shows that the inflated balloon of the temporary occlusion catheter is occluding the ICA. Right, Angiogram obtained after carotid artery stent placement. Two 10 x 30-mm Smart stents were deployed.