TRANSRADIAL APPROACH FOR CAROTID ARTERY STENTING WITH CEREBRAL PROTECTION. TECHNICAL NOTES AND REPORT AFTER 20 CASES.

Purpose: Carotid artery stenting is emerging as an attractive alternative to surgical endarterectomy for the treatment of carotid artery disease. The purpose of this study is to report our initial experience using the radial artery as access for carotid stenting.
Materials and Methods: A retrospective study was performed in which twenty patients, high risk for carotid endarterectomy, underwent carotid stenting with cerebral protection via either radial artery under local anesthesia. All procedures were performed in the operating room from March 2006 – December 2006. Seven lesions were symptomatic with carotid stenosis (>70%) and 13 lesions were asymptomatic with stenosis (>80%). Patients were evaluated for access site complications, procedural completion, patient mobilization, need for intravenous analgesia and development of neurologic complications (stroke or transient ischemic attacks (TIAs)).
Results: Procedural success was achieved in 18 patients (90%). The 30-day incidence of stroke and death was 0%. There was one puncture related complication: it was a radial artery occlusion in a patient with vasospasm. One patient had persistent local pain requiring intravenous medication for relief. All patients were mobilized within 2 hours of intervention and were discharged on the first post-operative day.
Conclusions: Carotid artery stenting with cerebral protection devices can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Further study is needed prior to recommending that femoral access be replaced by radial access for carotid artery intervention.