Introduction: Carotid artery stenting (CAS) using the femoral approach can be problematic due to access site complications, PVD or anatomical variations of the aortic arch. The purpose of the study is to describe our experience of CAS via the right radial approach (RRA).
Methods: Clinical and radiographical records of all patients treated with carotid stenting via right radial approach were retrospectively reviewed. The target common carotid artery was initially cannulated by using 5F either right, left Judkins, IMA or Simmons-1 diagnostic catheters. These catheters were advanced towards peripheral branches of the external CA system using Terumo 0.035" wire. Through the diagnostic catheters a 0.035 Extra stiff exchange wire was navigated to the External CA . Over this wire a 6F shuttle sheath was advanced to the distal common CA whereas the procedure was completed by the standard technique. All sheaths were removed immediately post procedure.
Results: Fifteen patients (pts); mean age 58 +/- 7, 13 male underwent CAS. All had CA stenosis > 70%, 9/15(60%) were asymptomatic. Eleven pts had right and 4 had left internal CA stenosis (3 Bovine and 1 normal aortic arch). CAS was successfully completed in 13/15 (87 %) pts including 10/15 with the right and 3/4 with the left CA stenosis. The single cause of technical failure was inadequate catheter support at the origin of the common CA. Mean procedure time was 35+ 7 minutes. No port of access neither neurological complications were recorded. Mean hospital stay was 1 +/- 2 days due to symptomatic bradycardia.
Conclusions: CAS using the RRA seems to be safe and technically feasible. This approach may be particularly useful for patients with right CA stenosis, Bovine artic arch and severe PVD.
Patient Care: Understanding the safety and efficacy of CAS via right transradial approach helps vascular neurosurgeons to choose the perferred access route while performing carotid stenting, if patient had difficult arch anatomy or severe periperal vascular disease.
Learning Objectives: To understand the risks and benefits of performing carotid stenting procedure via transradial approach.