Feasibility and Safety of Transradial Approach with 8-French Balloon Guide Catheter for Carotid Artery Stenting: Case...

The use of an 8-French (Fr) balloon guide catheter (BGC) for carotid artery stenting (CAS) using a transradial approach (TRA) has been limited by the small size of the radial artery (RA) and anatomical challenges, including difficulties with catheter navigation and concerns regarding device slippage. This study aimed to evaluate the technical feasibility and safety of TRA-CAS using an 8-Fr BGC.

We retrospectively reviewed consecutive patients who underwent TRA-CAS with an 8-Fr BGC (Emboguard [Cerenovus, Galway, Ireland], Flowgate2 [Stryker Neurovascular, Fremont, CA, USA], Optimo EPD FLEX [Tokai Medical Products, Aichi, Japan], or Branchor XS/XF [Asahi Intecc, Aichi, Japan]). Introduction of the BGC was performed with either a sheath-based or sheathless approach, selected at the discretion of the operator. Considering the outer diameter of the 8-Fr BGCs, the eligibility criteria included RA diameter ≥2.8 mm on vascular ultrasonography and a waveform other than type D by the BARBEAU test. Patient demographics and procedural and clinical outcomes at 90 days or later were evaluated.

Twenty-one CAS procedures were attempted using an 8-Fr BGC via the TRA; 19 (90.5%) procedures were planned via the conventional RA and 2 (9.5%) via the distal RA. The lesion side was the right side in 14 patients (66.7%) and the left side in 7 (33.3%). Radial access success was achieved in 20 of 21 cases (95.2%); the remaining case required conversion to a transbrachial approach due to access site hematoma. Among the 20 cases with successful radial access, CAS was completed via the TRA/transdistal radial approach without conversion (technical success, 100%). BGC prolapse toward the aortic arch was observed in 6 cases. Balloon inflation was performed to stabilize the BGC in all cases. In 1 of these 6 cases, turnover of the BGC at the aortic valve was additionally required due to prolapse into the aortic arch. One case required device exchange due to BGC kinking. RA occlusion occurred in 1 case (4.8%), with no major complications.

CAS via TRA with an 8-Fr BGC appears feasible and safe in patients with RA diameter ≥2.8 mm, and the balloon properties may improve stability under conditions of challenging anatomy, making this a valuable option for carotid revascularization.