Sheathless Distal Radial Access for Carotid Stenting

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Neuroendovascular Therapy

Background:

• Transradial access (TRA) is increasingly utilized for carotid artery stenting (CAS).
• Distal radial artery access in the anatomical snuff box (SB-TRA) presents a promising alternative to conventional TRA, potentially reducing bleeding and occlusive complications.
• Limitations in dedicated neurovascular catheters and sheaths have historically hindered radial access for CAS.

Purpose of the Study:

• To evaluate the feasibility and safety of a sheathless carotid artery stenting (CAS) technique using a distal radial artery approach in the anatomical snuff box (SB-dTRA).
• To demonstrate the utility of commonly available neurovascular materials for performing CAS via the SB-TRA.
• To assess procedural and access site outcomes in patients undergoing CAS with the SB-dTRA approach.

Main Methods:

• A sheathless system was employed for CAS utilizing a distal radial artery access in the anatomical snuff box (SB-dTRA).
• Standard, readily available neurovascular long sheaths were adapted for the procedure.
• Three patients with right carotid artery stenosis underwent CAS using the SB-TRA approach.

Main Results:

• Carotid artery stenting (CAS) was successfully completed in all three patients using the snuff box transradial access (SB-TRA) approach.
• No procedural complications were observed during or after the interventions.
• No access site complications were reported, highlighting the safety of the SB-dTRA technique.

Conclusions:

• Carotid artery stenting (CAS) can be safely and effectively performed using a distal transradial approach in the anatomical snuff box (SB-TRA).
• The utilization of conventionally available neurovascular long sheaths facilitates CAS via the SB-TRA route.
• The sheathless SB-dTRA technique offers a viable alternative for CAS, potentially minimizing access-related complications.