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New Devices and Techniques
Original research
Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis
  1. Tanaporn Jaroenngarmsamer1,
  2. Kartik Dev Bhatia2,
  3. Hans Kortman2,
  4. Emanuele Orru2,
  5. Timo Krings3
  1. 1 Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  2. 2 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  3. 3 Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Ms. Tanaporn Jaroenngarmsamer, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand; jannet-nu{at}hotmail.com

Abstract

Background Femoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.

Methods Three online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999–2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.

Results Seven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.

Conclusion Radial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.

  • stent
  • cervical
  • intervention
  • stenosis
  • stroke

https://doi.org/10.1136/neurintsurg-2019-014994

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    Footnotes

    • Contributors TJ was the primary author of the study protocol, was one of the two reviewers, performed data extraction and collation, assisted with data analysis, and drafted and revised the manuscript. She is the guarantor. KB was one of the two reviewers, performed data quality checking, undertook the data analysis, and edited the manuscript. HK advised upon and edited the study protocol, assisted with data analysis, and edited the manuscript. EO advised upon and edited the study protocol, assisted with data analysis, and edited the manuscript. TK supervised the project, acted as the senior reviewer in cases of non-consensus, advised upon and assisted with editing of the protocol, advised upon the methodology, and edited and helped revise the manuscript. All authors assisted in the design of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.