title: Transradial and transbrachial arterial approach for simultaneous carotid angiographic examination and stenting using catheter looping and retrograde engagement technique.
abstract: BACKGROUND
  The purpose of this study was to introduce a novel and safe technique with high procedural success for carotid artery stenting (CAS).
  
  
  METHODS
  From April 2004 to May 2009, 161 patients underwent CAS using either a high transradial arterial approach (TRA, defined as 10 cm above styloid process) or a transbrachial arterial approach (TBA) with a 7F arterial sheath. Selective carotid angiography was performed using a 6F Kimny guiding catheter and Teflon wire (260 cm in length) by Catheter Looping And Retrograde Engagement Technique (CLARET) with the guiding catheter seated on the right coronary cusp and its tip engaged into the common carotid artery (CCA). Teflon wire was introduced into the CCA again after the diagnostic procedure, followed by replacement of the 6F Kimny guiding catheter by a 7F Kimny catheter for CAS using one of the following techniques: (1) direct-engagement method, i.e., from right innominate artery into the right CCA; (2) looping method plus double-wire technique (utilized two Teflon wires to provide an adequate support) for both the right and left CCA; and (3) looping method plus a PercuSurge balloon anchoring at the external carotid artery.
  
  
  RESULTS
  This distinctive technique offered 100% diagnostic success and 99.4% CAS success. Two patients (1.2%) experienced major ischemic stroke after CAS and two (1.2%) died during hospitalization.
  
  
  CONCLUSIONS
  The results of the present study showed that high TRA/TBA using CLARET for CAS in patients with severe carotid artery stenosis is safe and technically feasible with an extremely high success rate.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsiu-Yu
authors.initials: HY
authors.lastname: Fang
authors.forename: Sheng-Ying
authors.initials: SY
authors.lastname: Chung
authors.forename: Cheuk-Kwan
authors.initials: CK
authors.lastname: Sun
authors.forename: Ali A
authors.initials: AA
authors.lastname: Youssef
authors.forename: Anuj
authors.initials: A
authors.lastname: Bhasin
authors.forename: Tzu-Hsien
authors.initials: TH
authors.lastname: Tsai
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Hisham
authors.initials: H
authors.lastname: Hussein
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D001916:Brachial Artery; D002545:Brain Ischemia / Q000209:etiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017534:Radial Artery; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013624:Taiwan; D016896:Treatment Outcome