A series of 2,000 consecutive femorocerebral angiographic studies is presented and the rate of success for carotid artery catheterization is calculated. Special emphasis is placed on patients above 50 years of age. 1. The results are as follows: a. Left carotid artery. Total rate of success is 99 per cent with no difference between males and females. In patients over 50 years of age (1,042 examined carotid arteries) the rate of success is 98 per cent. The lowest rate of success is in the 8th decade in males 95 per cent. b. Right carotid artery. Total rate of success is 98 per cent with very slight difference between males and females. In patients over 50 years of age (1,028 examined carotid arteries) the rate of success is 96 per cent. The lowest rate of success is in the 8th decade in females—91 per cent. Carotid artery catheterization through the femoral approach is highly successful even in elderly patients with atherosclerotic disease and can be achieved with relative ease and safety. 2. Successful catheterization depends on: a. Predesigned shape of the catheter. b. Skillful manipulation of the catheter and guidewire. In the average patient no special proficiency, although considerable experience is needed. 3. Complications: The small size and pliability of the catheter reduces the risk of injury to the intima of the catheterized vessel. The catheter should not be "pushed" into the vessel without having the soft tip of the guidewire protruding through the catheter. The over-all rate of complications was 2.25 per cent. There were 2 deaths (0.1 per cent), 5 (0.25 per cent) permanent and 25 (1.25 per cent) transient neurologic deficits. In 7 (0.35 per cent) patients the internal carotid artery was damaged by subintimal injection. Five (0.25 per cent) significant hematomas and 1 (0.05 per cent) case of thrombosis of the femoral artery were encountered. 4. The rate of failure is directly proportional to the patient’s age, severity of atherosclerosis and hypertensive disease. Congenital anomalies at the origin of the left carotid artery and congenital tortuosities of the brachiocephalic vessels play substantial roles in failures, when exaggerated by atherosclerosis and hypertension (they were the most important single reasons for our failures). The second cause of failure was atherosclerotic tortuosity of the pelvic arteries which significantly diminished the maneuverability of the catheter.
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Jiri J. Vitek (1973) studied this question.