title: Contralateral transradial approach for carotid artery stenting: a feasibility study.
abstract: BACKGROUND
  Carotid artery stenting (CAS) has become an accepted modality of treatment for revascularization of the internal carotid artery (ICA). CAS from femoral approach has got wide acceptance, however, it can be problematic due to access site complication as well as technical difficulties related to peripheral vascular disease and/or anatomical variations of the aortic arch. Small feasibility studies of CAS through ipsilateral transradial approach have been described in the literature. The purpose of the present study is to evaluate the feasibility of contralateral transradial approach as an alternative approach for CAS.
  
  
  METHODS
  Twenty patients (mean age: 65 +/- 5, 17 male) underwent CAS using contralateral transradial approach. All had a CA stenosis greater than 80%. The target common carotid artery (CCA) was initially cannulated via the contralateral radial artery using a 5F Simmons 1 diagnostic catheter or a 5F TIG diagnostic catheter, which was then advanced to the external CA (ECA) over an exchange length of 0.032'' Terumo Glidewire or a 0.025'' Glidewire. Once the catheter was parked in the optimal position in ECA, the wire was removed and was replaced by 0.035'' Amplatz Super stiff Guide wire. Following that, the Simmons 1 or the TIG catheter was removed and 6F Pinnacle Sheath was exchanged and positioned in the distal CCA. CAS was performed using standard techniques with weight-based heparin for anticoagulation.
  
  
  RESULTS
  CAS was successful in 16/20 (80%) patients, including 12/12 (100%) right CA, 4/8 (50%) left CA. Mean interventional time was 40 +/- 5 min. The sheath was removed immediately after the procedure. There were no radial access site complications. One patient sustained a transient ischemic attack and recovered completely with complete resolution of symptoms within 1 hr. Median Hospital stay was 3 +/- 0.5 days. Angulation of left CCA with the aortic arch was the technical cause of failure in the four unsuccessful cases.
  
  
  CONCLUSIONS
  CAS using the contralateral transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions because of the favorable right CCA angle with the aortic arch.
authors.affiliation: NHL Municipal Medical College, Sheth V.S. General Hospital, Ahmedabad, India. tejaspatel@tcvsgroup.org
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shah
authors.forename: Alok
authors.initials: A
authors.lastname: Ranjan
authors.forename: Hemant
authors.initials: H
authors.lastname: Malhotra
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: John
authors.initials: J
authors.lastname: Coppola
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants