Access site complications with carotid angioplasty and stenting

Carotid angioplasty and stenting is a relatively new therapeutic alternative to CEA for treatment of carotid stenosis. The percutaneous transfemoral approach, the standard technique for angioplasty and stent deployment, may not be feasible in all patients. We present our experience with access site complications that occurred with CAS.

One hundred thirty-two CAS procedures were performed at our institution in the past 5 years for symptomatic (62.1%) or asymptomatic (37.9%) carotid stenosis. Mean age of patients was 70.72 +/- 6.53 years and the mean degree of stenosis of the treated carotids was 80.74% +/- 11.83%. The transfemoral approach was the access route in 126 CAS, the transbrachial approach was used in 2 CAS procedures, and direct carotid exposure was used in 5 patients.

All CAS procedures were done successfully; 4 (3%) access site complications were detected, 3 (2.4%) groin hematomas with transfemoral approach and 1 hematoma on the left side of the neck, in patients treated with direct carotid cutdown. Surgical repair of FSA was successfully performed for the patients with groin hematoma, whereas surgical wound exploration in the neck for the remaining patient revealed no identifiable cause. All patients received blood transfusion for correction of associated hypovolemia or hemorrhagic anemia. No patients had experienced access site-related additional cardiac, systemic, or neurologic events.

The authors' experience demonstrates that access site complications are rare events with CAS despite the large diameter of implantable devices and liberal anticoagulant and antiplatelet therapy. Transbrachial and direct carotid approaches are relatively safe, accepted alternatives in the setting of contraindicated femoral access.