Transradial approach for carotid artery stenting: a feasibility study.
BACKGROUND
Carotid artery stenting (CAS) has become accepted as an alternative to carotid endarterectomy for revascularization of the internal carotid artery (ICA) among high risk patients. CAS from the femoral approach can be problematic due to access site complications as well as technical difficulties related to peripheral vascular disease (PVD) and/or anatomical variations of the aortic arch. The purpose of the present study is to evaluate the feasibility of the radial artery as an alternative approach for CAS.


METHODS
Forty-two patients (mean age 71 +/- 1, 26 male) underwent CAS. All had a CA stenosis greater than 80% and comorbid conditions increasing the risk of carotid endarterectomy. The target common carotid artery (CCA) was initially cannulated via the radial artery using a 5F Simmons 1 diagnostic catheter which was then advanced to the external CA (ECA) over an extra support 0.014" coronary guidewire. After removing the coronary guidewire, a 0.035" guidewire was advanced into the ECA, and the Simmons 1 was exchanged for a 5F or 6F shuttle sheath and positioned in the distal CCA. In four patients with a bovine aortic arch, the left CCA was accessed with a 5F Amplatz R2 catheter which was then exchanged for a shuttle sheath over a 0.035" guidewire. CAS was performed using standard techniques with weight-based bivalirudin for anticoagulation.


RESULTS
CAS was successful in 35/42 (83%) patients, including 28/29 (97%) right CA, 4/5 (80%) bovine left CA, 7/13 (54%) left CA. Mean interventional time was 30 +/- 3 minutes. The sheath was removed immediately after the procedure. There were no radial access site complications. One patient sustained a stroke 24 hrs after the procedure with complete resolution of symptoms (Mean NIH stroke scale 2.0 +/- 0.3 before, 1.9 +/- 0.3 after). Median hospital stay was 2 +/- 0.6 days. Inadequate catheter support at the origin of the CCA was the technical cause of failure in the seven unsuccessful cases.


CONCLUSIONS
CAS using the transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions and severe PVD or unfavorable arch anatomy, and among patients with a bovine aortic arch.
Folmar
Jessica
J
Wake Heart and Vascular Associates, Wake Heart Center, 3000 New Bern Avenue, Raleigh, NC 27610, USA.
Sachar
Ravish
R
Mann
Tift
T
D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006629:Hirudins; D006801:Humans; D007902:Length of Stay; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use; D011474:Prosthesis Design / Q000295:instrumentation; D017534:Radial Artery / Q000601:surgery*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012107:Research Design; D015607:Stents; D016896:Treatment Outcome
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin