Related Experiment Videos
Transradial stenting of the cervical internal carotid artery: technical case report
Elad I Levy1, Stanley H Kim, Bernard R Bendok
1Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
Insights
Transradial access offers a viable alternative for carotid artery stenting when traditional femoral access is challenging. This approach successfully treated severe internal carotid artery stenosis, highlighting its potential for complex cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Procedures
Background:
- Severe internal carotid artery stenosis poses a significant risk of stroke.
- Traditional transfemoral access for endovascular procedures can be complicated by prior surgeries or occlusive disease.
- Endoluminal revascularization is a key treatment for carotid artery stenosis.
Observation:
- A 69-year-old male with extensive vascular disease presented with severe, progressive right internal carotid artery stenosis.
- Transfemoral access was deemed complicated due to a history of iliofemoral bypass graft and aortoiliac occlusion.
- A transradial approach was successfully utilized for stent placement.
Findings:
- Percutaneous access via the radial artery was achieved for endoluminal stent placement.
- A Precise stent was successfully deployed in the cervical internal carotid artery.
- The transradial approach provided a safe and effective alternative to transfemoral access in this complex patient.
Implications:
- The transradial approach is a feasible alternative for carotid artery stenting in patients with challenging femoral access.
- Advancements in device technology are likely to increase the utility of the transradial route for cervical and intracranial interventions.
- This case supports the expanding role of radial artery access in complex neurovascular procedures.
Objective And Importance:
We describe a case of endoluminal stent placement for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the radial artery.
Clinical Presentation:
A 69-year-old man with known disease of the carotid, peripheral, and coronary arteries as well as chronic obstructive pulmonary disease presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis.
Technique:
Transfemoral access was complicated by the previous placement of a synthetic graft as the result of a previous right-to-left iliofemoral artery bypass procedure and an aortoiliac occlusion. A transradial approach was successfully attempted, and a Precise stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 6-French guide sheath.
Conclusion:
The transradial approach is becoming an increasingly viable alternative route for stent placement in patients with contraindicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the transradial route will be used with increasing frequency in this select patient population for stenting of both the cervical and intracranial circulation.