Carotid Stenting Using Radial Artery Access

BackgroundCarotid artery stenting (CAS) is a procedure for stroke prevention, usually done from femoral artery access. Reports of CAS using radial artery access have adopted techniques similar to those used for transfemoral CAS. Initial experience with a simpler and lower profile technique for transradial carotid stenting is described here.MethodsOf 55 consecutive elective CAS cases with standard (not bovine) arch anatomy performed during a 15 month time period by the same operator, 20 were selected for transradial treatment using a 6 F Simmons 2 guide catheter. This was a retrospective analysis of those initial 20 patients compared with the 35 patients treated with elective transfemoral CAS. The CAS database was reviewed for clinical indications, technique, procedure and fluoroscopy times, and clinical outcomes.ResultsAll procedures were technically successful (no crossovers). No patient had a decline in National Institutes of Health Stroke Scale score or modified Rankin Scale score within 30 days. Mean (95% CI) procedural times for transradial CAS were slightly higher than transfemoral CAS (29.4 (26.0 to 32.7) vs 23.8 (21.2 to 26.4) min, p=0.0098). Mean (95% CI) fluoroscopy times were also higher for transradial CAS compared with transfemoral CAS (9.6 (8.0 to 11.2) vs 6.4 (5.4 to 7.4), p=0.0006). One patient developed a radial artery pseudoaneurysm which required elective surgical repair.ConclusionTransradial carotid stenting using the described lower profile technique provides another effective option in the array of surgical procedures for the treatment of carotid artery stenosis. Relative procedural and fluoroscopy times may initially be longer compared with transfemoral carotid stenting for experienced CAS operators, although absolute differences are small.

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Carotid Stenting Using Radial Artery Access

Journal of Endovascular Therapy ◽

10.1177/152660289900600418 ◽

1999 ◽

Vol 6 (4) ◽

pp. 385-386 ◽

Cited By ~ 6

Author(s):

Fausto Castriota ◽

Alberto Cremonesi ◽

Raffaella Manetti ◽

Mauro Lamarra ◽

Giorgio Noera

Keyword(s):

Radial Artery ◽

Carotid Stenting

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Carotid Stenting

Radial Access for Neurointervention ◽

10.1093/med/9780197524176.003.0008 ◽

2021 ◽

pp. 69-76

Author(s):

Omaditya Khanna ◽

Nikolaos Mouchtouris ◽

Eric C. Peterson ◽

Pascal M. Jabbour

Keyword(s):

Carotid Artery ◽

Radial Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Large Scale ◽

Treatment Options ◽

Carotid Stenting ◽

Artery Stenosis ◽

Carotid Artery Stent ◽

Recovery Times

Several large-scale studies have corroborated the indications for carotid artery revascularization in patients who present with carotid artery stenosis. The two treatment options are carotid endarterectomy and carotid artery stent, both of which show equipoise in outcomes, and although the latter is associated with increased risk of periprocedural stroke, it confers the benefit of shorter procedural and recovery times. Currently, radial artery access is rarely used for placement of carotid artery stents, both among neurosurgeons and vascular surgeons. However, radial artery access for carotid stent placement has been shown to be safe and efficacious, and it confers the benefit of reduced access-site complications and improved patient satisfaction measures. In this chapter, aimed at practitioners who would like to incorporate radial artery access into their clinical practice, we review the evaluation and management of carotid artery stenosis and present an operative technique for carotid artery stent placement via radial artery access.

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