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Chapter 5. Peripheral Anatomy for the Interventionalist

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The most common anatomic variant in aortic arch anatomy, occurring in 15% of the population, is a common ostium of the ________________ and __________________.

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A. Brachiocephalic and left common carotid arteries

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B. Left common carotid and left subclavian arteries

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C. Brachiocephalic and left subclavian arteries

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D. Brachiocephalic and left vertebral arteries

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The correct answer is A.

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The most common variant of the aortic arch anatomy is a shared ostium of the brachiocephalic artery and the left carotid artery, which occurs in 15% of the population.

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What is the most challenging type of aortic arch for both diagnostic imaging and therapeutic intervention?

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A. Type I

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B. Type II

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C. Type III

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The correct answer is C.

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The type III aortic arch represents the most difficult arch anatomy for both diagnostic and therapeutic interventional procedures. Because the aortic arch is highly angulated in the type III anatomy, catheter selection is key to being able to properly selectively engage the desired vessel and achieve adequate support for catheter-based intervention.

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The nerve that mediates the baroreceptor reflex typically seen during carotid intervention is the __________ nerve.

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A. Trigeminal

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B. Hypoglossal

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C. Glossopharyngeal

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D. Vagus

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E. Abducens

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The correct answer is C.

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The proximal portion of the carotid bifurcation houses the carotid sinus that regulates baroreceptor reflexes via the glossopharyngeal nerve and can cause bradycardia and hypotension during carotid intervention.

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During carotid intervention, it is critical to maintain wire position below the ___________ to avoid intracerebral perforation or dissection.

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A. Mandible

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B. External carotid

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C. Siphon or “S” portion of the internal carotid

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D. Cavernous portion

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The correct answer is C.

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It is critical to maintain wire position below the level of the siphon because an intracranial perforation or dissection could occur if the wire or a distal protection device is allowed to enter the intracranial carotid.

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