The transradial approach for carotid artery stenting.
BACKGROUND
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for revascularization of the internal carotid artery (ICA). CAS from the femoral approach may be problematic due to peripheral vascular disease, anatomical variations of the aortic arch, and access site complications. The purpose of this study was to evaluate the right radial approach (RRA) for CAS.


METHODS
A retrospective analysis of all patients who had undergone transradial (TR) CAS at two centers was performed. Demographics, the technique used to deploy the sheath in the common carotid, procedural details, results, and complications were evaluated.


RESULTS
CAS was attempted from TR in 382 patients (mean age 68, 70% male). CAS was successful in 347/382 (91%) patients; 201/216 (93%) right CA, 14/16 (88%) bovine left CA, 132/150 (88%) left CA. The specific technique varied with the anatomy. Seven different carotid artery stents (51% Xact) and seven different distal embolic protection devices were used. Adverse events included two major strokes (0.6%) one of whom died, three minor strokes (1%), and no myocardial infarction at 30 days. No bleeding complications occurred although 23 (6%) of patients had asymptomatic postprocedure radial occlusion. Inadequate catheter support at the origin of the CCA was the technical cause of failure in the unsuccessful cases which were then completed from femoral access as part of the same procedure.


CONCLUSIONS
The transradial approach is an alternative for CAS in the presence of factors that increase the risk or difficulty of femoral access.
Wake Heart and Vascular Associates, Raleigh, North Carolina 27610, USA.
Nicholena
N
Etxegoien
Diana
D
Rhyne
Sasko
S
Kedev
Ravish
R
Sachar
Tift
T
Mann
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000209:etiology; D002340:Carotid Artery Diseases / Q000401:mortality / Q000628:therapy*; D057505:Embolic Protection Devices; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009657:North Carolina; D011474:Prosthesis Design; D017534:Radial Artery; D018843:Republic of North Macedonia; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome