[Carotid artery stenting via transbrachial approach]

The transbrachial approach as an alternative access site for carotid artery stenting (CAS) has mainly been published as case reports. This paper evaluates transbrachial CAS at our institute for the past 5 years and refers to the complications and results of this method.

From January 2003 to April 2008, we performed 299 CAS of which 12 (4%, 11 male, 1 female) were performed with a transbrachial approach. The average age of these patients was 67.4 years (+/- 9.75). The average degree of stenosis of the treated carotid artery was assessed by Doppler ultrasound (81.5% +/- 10.66) and digital subtraction angiography (DSA) using the NASCET criteria (75.9% +/- 9.75). 9 / 12 patients (75%) were treated because of symptomatic stenosis.

The transbrachial approach was performed in 8 patients because of high-grade stenosis of the femoral and/or iliac arteries. 4 patients showed severe elongation of the aortic arch. 11 of 12 (92%) of the transbrachial CAS were performed successfully. The approach was judged to be only slightly more challenging than puncture of the femoral artery. No minor or major complications occurred at the access site. 3 of 11 patients (27%) showed residual stenosis after CAS of 24% (+/- 7.78).

The transbrachial approach for CAS is rarely required compared to the transfemoral approach. Especially in cases of femoral or iliac artery stenosis and severe elongated and calcified aortic arches, it is an elegant alternative approach with rare complications.