DIRECT-SIMMONS/DIRECT-TRACE technique for transradial carotid artery stenting using a novel composite-tip guide...

To evaluate the efficacy and safety of a novel DIRECT-SIMMONS/DIRECT-TRACE technique utilizing a composite-tip guiding catheter for transradial carotid artery stenting, addressing the limitations of conventional approaches requiring multiple catheter exchanges. This retrospective, multicenter study included 90 consecutive patients with carotid artery stenosis who were treated between July 2024 and June 2025. All procedures utilized the Fastroad™ composite-tip guiding catheter with the DIRECT-SIMMONS technique for positioning and the DIRECT-TRACE technique for embolic protection device retrieval. The primary endpoints included successful catheter positioning and stent placement. Technical success was achieved in all 90 patients (100%) for both catheter positioning and stent placement for the internal carotid artery (ICA) or Common carotid artery (CCA), with no conversion to the transfemoral approach. The first-attempt success rates were 87.8% for catheter positioning and 82.2% for retrieval of the embolic protection device using the DIRECT-TRACE technique. The mean procedure time was 36.61 ± 11.59 min. Periprocedural complications with minor stroke in 2 patients (2.2%), 4.4% asymptomatic radial artery occlusion and no death or major vascular injury. At a median follow-up of 4.5 months, the asymptomatic restenosis rate of ICA was 5.3%. The DIRECT-SIMMONS/DIRECT-TRACE technique provides a safe, effective, and streamlined single-catheter approach for transradial carotid artery stenting with high success rates and minimal complications. This method offers a preferable alternative for transradial neurointerventional procedures.