Report on initial experience with transradial access for carotid artery stenting.
OBJECTIVE
Carotid artery stenting is emerging as an attractive alternative to surgical endarterectomy for the treatment of carotid artery disease. This study reports our initial experience using the radial artery as access for carotid stenting.


METHODS
A retrospective study was performed in which 20 consecutive patients at high risk for carotid endarterectomy underwent carotid stenting with cerebral protection using radial artery access. All procedures were performed in the operating room from March 2006 to December 2006. Seven lesions were symptomatic, and 13 lesions were asymptomatic. Patients were evaluated for development of stroke or transient ischemic attacks, myocardial infarction, access site complications, procedural success, time to patient mobilization, and need for intravenous analgesia.


RESULTS
Procedural success was achieved in 18 patients (90%). Intense radial artery vasospasm resulted in one failure, and the second failure occurred in a patient with a left-sided carotid lesion and type I arch. The 30-day incidence of stroke, transient ischemic attacks, myocardial infarction, and death was 0%. Radial artery occlusion only occurred in the one patient because of the development of intense vasospasm during the procedure. One patient had persistent local pain requiring intravenous medication for relief. All patients were mobilized <or=2 hours of intervention and were discharged on the first postoperative day.


CONCLUSIONS
Carotid artery stenting with cerebral protection devices can be safely and effectively performed, with acceptable morbidity and high technical success, by using radial artery access. We recommend obtaining imaging of the aortic arch and supra-aortic trunks with computed tomography, as well as a duplex scan of radial artery, before attempting carotid artery stenting using radial artery access. Further study is needed before recommending that femoral access be replaced by radial access for carotid artery intervention.
Pinter
Laszlo
L
Department of Vascular Surgery and Endovascular Interventions, Augusta Hospital, Düsseldorf, Germany. drpinter@t-online.de
Cagiannos
Catherine
C
Ruzsa
Zoltan
Z
Bakoyiannis
Chris
C
Kolvenbach
Ralf
R
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017534:Radial Artery / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex