Transradial Versus Transfemoral Carotid Artery Stenting: A 16-Year Single-Center Experience

Area of Science:

• Cardiovascular Interventions
• Vascular Surgery
• Interventional Neurology

Background:

• Limited data exist on the safety and efficacy of transradial access for carotid artery stenting (CAS).
• Transfemoral access is the traditional approach for CAS, but carries potential complications.
• Comparing transradial (TR) and transfemoral (TF) access in CAS is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the outcomes and complication rates of transradial (TR) versus transfemoral (TF) access in patients undergoing carotid artery stenting (CAS).
• To evaluate the safety, efficacy, and procedural success of TR-CAS compared to TF-CAS.

Main Methods:

• A single-center retrospective study evaluating 775 consecutive patients undergoing CAS with cerebral protection between 1999 and 2016.
• Patients were divided into two groups based on vascular access: transradial (TR, n=101) and transfemoral (TF, n=674).
• Primary endpoint was in-hospital major adverse cardiac and cerebral events; secondary endpoints included angiographic success and crossover rates.

Main Results:

• Angiographic success was achieved in all patients (100%).
• The crossover rate from TR to TF access was 4.9%, while the TF group had 0% crossover (P < 0.05).
• In-hospital major adverse cardiac and cerebral events occurred in 2% of the TR group and 3.6% of the TF group (P = not significant).

Conclusions:

• Transradial access for carotid artery stenting is a safe and effective technique.
• The TR approach demonstrates acceptable crossover rates and low incidence of vascular complications, comparable to the TF approach.
• TR-CAS is a viable alternative to TF-CAS, particularly for patients at high risk for carotid endarterectomy.