Feasibility and safety of transbrachial approach for patients with severe carotid artery stenosis undergoing stenting.
Although sporadic successful cases using the transradial approach (TRA) for carotid stenting have been reported, the safety and feasibility of carotid stenting using either TRA or a transbrachial approach (TBA) have not been fully investigated. Recently, we have developed a safe and feasible method of TRA for cerebrovascular angiographic studies. This study investigated whether a TBA approach using a 7-French (F) Kimny guiding catheter for carotid stenting is safe and feasible for patients with severe carotid stenosis. Thirteen patients were enrolled into this study (age range, 63-78 years). Seven of these 13 patients had severe peripheral vascular disease. A retrograde-engagement technique, involving looping 6-F Kimny guiding catheter, was utilized for carotid angiographic study. For carotid stenting, the 6-F Kimny guiding catheter was replaced with a 7-F Kimny guiding catheter, and the procedure was performed as the follows. First, an extra-support wire was inserted into the middle portion of external carotid artery (ECA). Second, a 0.035-inch Teflon wire was advanced into the common carotid artery. Then, the 6-F guiding catheter was exchanged for a 7-F Kimny guiding catheter. Third, if the first and second steps did not provide adequate support for exchanging the guiding catheter, a PercuSurge GuardWire was inserted into the ECA, followed by distal balloon inflation for an anchoring support. FilterWire EX was used in 9 patients and PercuSurge GuardWire in 4 patients to protect from distal embolization during the procedure. The procedure was successful in all patients. No neurological or vascular bleeding complications were observed and all patients were discharged uneventfully. The TBA for carotid stenting was safe and effective, providing a last resort for patients unsuited to femoral arterial access and surgical intervention.
Wu
Chiung-Jen
CJ
Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
Cheng
Cheng-I
CI
Hung
Wei-Chin
WC
Fang
Chih-Yuan
CY
Yang
Cheng-Hsu
CH
Chen
Chien-Jen
CJ
Chen
Yen-Hsun
YH
Hang
Chi-Ling
CL
Hsieh
Yuan-Kai
YK
Chen
Shyh-Ming
SM
Yip
Hon-Kan
HK
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D015607:Stents