title: Carotid artery stenting in patients with left ICA stenosis and bovine aortic arch: a single-center experience in 60 consecutive patients treated via the right radial or brachial approach.
abstract: OBJECTIVE
  To assess the safety and efficacy of carotid artery stenting (CAS) of the left internal carotid artery (LICA) from a right radial/brachial approach in patients with bovine aortic arch.
  
  
  METHODS
  Among 505 consecutive CAS patients treated at our facility between June 2007 and December 2012, 60 (11.9%) patients (44 men; mean age 73±9 years) with LICA stenosis and bovine arch were treated from a right radial (n=32) or brachial (n=28) approach. Three quarters of the patients had characteristics qualifying them at high surgical risk; 52 were asymptomatic. The types of cerebral protection (a distal filter or proximal MO.MA system), stent, and technique were at the operation's discretion.
  
  
  RESULTS
  The radial/brachial approach was successful in 59 (98.3%) of 60 procedures; 1 case was converted to a femoral approach. Proximal protection was used in 15 cases (11 brachial, 4 radial) with severe, soft plaques, although the MO.MA system proved too short in a tall patient having a radial approach and a filter was used. Clinical success with no adverse events was 96.7% owing to 1 retinal embolism and 1 minor stroke. Vascular complications occurred in 2 (3.3%) brachial group patients. No major bleeding was encountered. Over a mean follow-up of 18.7±17.5 months, midterm event-free survival was 93%. No target vessel revascularization was necessary.
  
  
  CONCLUSIONS
  CAS via a right radial or brachial approach is safe and effective in patients with LICA stenosis and types 1 or 2 bovine arch.
authors: 1 Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors: Piero
authors: P
authors: Montorsi
authors: Stefano
authors: S
authors: Galli
authors: Paolo M
authors: PM
authors: Ravagnani
authors: Daniela
authors: D
authors: Trabattoni
authors: Franco
authors: F
authors: Fabbiocchi
authors: Alessandro
authors: A
authors: Lualdi
authors: Giovanni
authors: G
authors: Ballerini
authors: Daniele
authors: D
authors: Andreini
authors: Gianluca
authors: G
authors: Pontone
authors: Luigi
authors: L
authors: Caputi
authors: Antonio L
authors: AL
authors: Bartorelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001027:Aortography / Q000379:methods; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D018572:Disease-Free Survival; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017534:Radial Artery / Q000000981:diagnostic imaging; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome