[Transradial approach in carotid stenting]

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• The transfemoral approach is standard for carotid artery stenting due to ease of use and large catheter compatibility.
• Challenges arise with transfemoral access in cases of atherosclerosis, tortuous arteries, or specific aortic arch anatomy.
• The transradial approach aims to reduce puncture-site bleeding and minimize patient immobility post-procedure.

Purpose of the Study:

• To conduct a comparative analysis of transradial versus transfemoral approaches for carotid artery stenting.
• To evaluate clinical and angiographic outcomes, technical aspects, and complication rates between the two access methods.

Main Methods:

• Retrospective analysis of 168 patients undergoing carotid artery stenting across two centers (2012-2017).
• Patients were divided into transradial (75) and transfemoral (93) groups.
• Comparison included neurological events (stroke, TIA), myocardial infarction, local complications, procedure success, and operative parameters.

Main Results:

• Procedure success was 100% in both groups; conversion rates were 4% (radial) and 1% (femoral) (p=0.087).
• Neurological complication rates (disabling and minor stroke) and 30-day outcomes (mortality, MI, bleeding) showed no significant differences.
• Asymptomatic radial artery occlusion occurred in 9.3% of the transradial group; no significant differences in operation time, radiation, or hospital stay were noted.

Conclusions:

• The transradial approach is a safe and effective alternative for carotid artery stenting.
• It is particularly beneficial for patients at high risk of hemorrhagic complications or those with challenging aortic arch and iliofemoral anatomy.
• The transradial approach offers comparable efficacy to the transfemoral route while potentially mitigating access-site complications.