Abstract 3834: The Transradial Approach for Carotid Artery Stenting: A Feasibility Study
Background: Carotid artery stenting (CAS) has become accepted as an alternative to carotid endarterectomy for revascularization of the internal carotid artery (ICA) among high risk patients. CAS from the femoral approach can be problematic due to access site complications as well as technical difficulties related to peripheral vascular disease (PVD) and/or anatomical variations of the aortic arch. The purpose of the present study is to evaluate the feasibility of the radial artery as an alternative approach for CAS.
Methods: Thirty-three patients (mean age 71±1.2, 19 male) underwent CAS. All had a CA stenosis greater than 80% and comorbid conditions increasing the risk of carotid endarterectomy. The target common carotid artery (CCA) was initially cannulated via the radial artery using a 5F Simmons 1 diagnostic catheter which was then advanced to the external CA (ECA) over an extrasupport 0.014“ coronary guidewire. After removing the coronary guidewire, a 0.035” guidewire was advanced into the ECA, and the Simmons 1 was exchanged for a 5F or 6F shuttle sheath and positioned in the distal CCA. In four patients with a bovine aortic arch, the left CCA was accessed with a 5F Amplatz R2 catheter which was then exchanged for a shuttle sheath over a 0.035“ guidewire. CAS was performed using standard techniques with weight-based bivalirudin for anticoagulation.
Results: CAS was successful in 28/33 (85%) patients, including 21/22 (95%) right CA, 4/4 (100%) bovine left CA, 3/7(43%) left CA. Mean interventional time was 38±3 minutes. The sheath was removed immediately after the procedure. There were no radial access site complications or neurological complications (Mean NIH stroke scale 1.8±0.3 before, 1.8±0.3 after). Mean hospital stay was 3±0.4 days. In all five unsuccessful cases, the shuttle sheath could not be advanced into the CCA due to inadequate catheter support.
Conclusion: CAS using the transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions and severe PVD or unfavorable arch anatomy, and among patients with a bovine aortic arch. Further refinement of technique may allow applicability of the radial approach to a larger patient population.