The transradial approach for carotid artery stenting

Abstract

The transradial approach is an alternative for CAS in the presence of factors that increase the risk or difficulty of femoral access.

Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent

“…Recently, we have reported our dual-center experience in >300 patients using radial access and carotid stenting with several techniques and stent designs. 2 Overall, risks of complications were small with a combined death or major stroke rate of 0.5% at 30 days.…”

“…1,9,10,12,13 However, several groups have reported their experience with carotid stenting and radial access. 2,5,11,12 Transradial approach for carotid artery stenting also offers minimal contact with catheter and aortic arch, which may reduce the risk of stroke, especially with right internal carotid or bovine left internal carotid artery. Over the years, we have gained much experience using the right radial or ulnar artery as preferred access for right and left carotid arteries stenting.…”

“…As previously reported, for simple anatomies we used either the anchoring technique and for more complex anatomic situations, we used the telescopic technique. 1,2,5 For the anchoring technique, the initial diagnostic catheter was positioned into the external carotid artery over a 0.035 00 wire 260-cm length (Advantage; Terumo Medical, Leuven, Belgium). Then, 5Fr diagnostic and short sheaths were removed and a 90-cm 5Fr Destination sheath (Terumo Medical, Leuven, Belgium) was advanced over the 0.035 00 wire just distal to carotid arteries bifurcation.…”

Carotid Artery Stenting With Proximal Embolic Protection via a Transradial or Transbrachial Approach

“…Moreover, the short protrusion of the mandrel outside the working channel ( Figure 6A) further reduces device trackability and pushability. 9 Hostile anatomy in all 10 (13/130) 10 6 Hostile anatomy Crossover to filter 6 (4/61) Acute intolerance --…”

“…(Death, all strokes, MI) b 0 (0/55) 2.8 (4/142) 1 Major and 3 minor strokes 1.7 (6/347) 9 1 Death, 1 major and 3 minor strokes 0.9 (1/117) 10 1 6.0 (23/347) 9 5-6-F IS in 85% 6.8 (8/117) 10 7-F GC in 90% These limitations may be overcome with 2 techniques. The first is the "wire reshaping" technique that keeps the wire below the bifurcation, limiting the risk of inadvertently crossing the lesion, maintaining good support for advancing the whole system.…”