Report on initial experience with transradial access for carotid artery stenting

Abstract

Carotid artery stenting with cerebral protection devices can be safely and effectively performed, with acceptable morbidity and high technical success, by using radial artery access. We recommend obtaining imaging of the aortic arch and supra-aortic trunks with computed tomography, as well as a duplex scan of radial artery, before attempting carotid artery stenting using radial artery access. Further study is needed before recommending that femoral access be replaced by radial access for carotid artery intervention.

Transradial Neuroendovascular Treatment for Anterior Circulation Lesions: An Initial Experience with a 6 Fr Guiding Sheath

“…14) A study reported that the intra-arterial administration of 50% isosorbide dinitrate reduced vasospasm or pain, 15) and another report indicated the efficacy of sedation with a venous anesthetic. 13) We performed treatment under general anesthesia to overcome problems regarding pain and to gain better maneuverability.…”

“…[8][9][10][11][12][13] However, according to some studies, when treating left lesions, a guiding system may be drawn into the aortic direction, which depends on the bifurcation angle of the left common carotid artery, making guiding impossible, or it may fall off during the procedure due to its instability. 11,13) In this study, we could navigate a 6 Fr guiding sheath into the common carotid artery using the right radial artery approach in all patients regardless of the left/right side of the targeted blood vessel, and accomplish neuroendovascular treatment postoperative complications. To achieve this, access routes were anatomically evaluated using 3D-CTA, volume rendering MRA, or cerebral angiography before endovascular treatments in all patients.…”

Transbrachial Angioplasty and Stenting without Crossing the Aortic Arch for Right Carotid Artery Stenosis Patients with Complex Aortic Plaques

“…Several authors have reported CAS without crossing the aorta. 6,7) These techniques require insertion of guide wire into external carotid artery and catheter exchange using long wire. These techniques may be inappropriate for patients with CCA stenosis.…”

“…6,7) They have described the use of transbrachial or transradial access, guiding sheath exchange over the long wire using a pigtail or internal mammary artery (IMA) type diagnostic catheter. 6,7) These techniques require insertion of guide wire into external carotid artery 6,7) and may be inappropriate for patients with common carotid artery (CCA) stenosis. To overcome these drawbacks, we developed a novel and simple technique of carotid angioplasty and stenting without crossing the aortic arch, guide wire insertion into external carotid artery, and catheter exchange.…”

Allen’s test in patients with peripheral artery disease

“…Transradial (TR) approach for coronary and peripheral angiography and angioplasty has become a popular technique [1][2][3][4][5]. The Allen's test (AT), first described in 1929, could be used to determine the presence of collateral flow in the hand [6].…”