Wrist Access Found Suitable for Carotid Stenting

A new study shows that wrist access for carotid artery stenting (CAS) can have excellent outcomes for patients with peripheral vascular disease and other factors that make conventional femoral access more risky.

Researchers at Wake Heart and Vascular Associates (Raleigh, NC, USA) conducted a retrospective analysis of 382 patients (mean age 68, 70% male) who had undergone transradial (TR) CAS at two centers. Demographics, the technique used to deploy the sheath in the common carotid, procedural details, results, and complications were evaluated. The results showed that total CAS was successful in 91% patients; 93% right CA, 88% in bovine left CA, and 88% in left CA. The specific technique varied with the anatomy.

Seven different carotid artery stents and seven different distal embolic protection devices were used. Adverse events included two major strokes (0.6%) one of whom died, three minor strokes (1%), and no myocardial infarction (MI) at 30 days. No bleeding complications occurred, although 6% of the patients had asymptomatic postprocedure radial occlusion. Inadequate catheter support at origin of the common carotid artery (CCA) was the technical cause of failure in the unsuccessful cases, which were then completed from femoral access as part of the same procedure.

“The low incidence of periprocedural death, stroke, and myocardial infarction was comparable with other large studies of carotid stenting from femoral access and/or endarterectomy,” concluded lead author Tift Mann, MD, and colleagues. “The transradial approach is an alternative for carotid artery stenting in the presence of factors that increase the risk or difficulty of femoral access.”

CAS is an alternative to carotid endarterectomy (CEA) for revascularization of the internal carotid artery. CAS from the femoral approach may be problematic due to peripheral vascular disease, anatomical variations of the aortic arch, and access site complications. The TR approach may cut down on catheter contact with the aortic arch, which is the source of emboli typically responsible for procedure-related stroke.

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