Sheathless Distal Radial Access for Carotid Stenting

Carotid artery stenting through radial artery access is limited by the lack of dedicated neurovascular catheters and sheaths. Transradial access (TRA) is now widely used for carotid artery stenting [CAS]. Distal radial access in the snuff box (SB-TRA) offers an even more attractive option that lowers bleeding and occlusive complications than even conventional TRA. We report the use of a sheathless system for CAS using commonly available materials using a snuff box approach and distal radial access (SB-dTRA). Three patients underwent CAS of the right carotid artery using an SB-TRA approach. All three were completed satisfactorily without any procedural or access site complications. By using conventionally available dedicated neurovascular long sheaths, it is possible to perform CAS using the snuff box trans-radial route.