Introduction Transradial neurointerventional procedures have become increasing popular in the past few years including carotid stenting, however lack of a dedicated workhorse catheter for transradial carotid stenting leave much to be desired. Here we describe our initial experience of transradial carotid stent using a low profile 6F Envoy Simmons-2 guide catheter and comparison of safety and efficacy to conventional transfemoral approach.

Materials and Methods We retrospectively analyzed all consecutive elective CAS procedures performed at our institute in last 12 months by same neurointerventionalist and divided procedures based on initial approach (transradial/transfemoral). Both approaches were used to minimize inter-operator variability. Transradial cases were done on an all-comer basis after enough procedural experience with the 6F Sim2 guide catheter was attained without any strict exclusion criteria other than severe right subclavian artery stenosis. Although this method limits stent size to 8 mm, it proved to be a more reliable guide catheter. We reviewed clinical indications, technical success including crossover rates, procedure and fluoroscopy times, clinical outcomes, and complications rates.

Results Of the total 35 consecutive elective CAS procedures performed; 16 were initiated as transradial approach but 4 (25% crossover rate) of them had to be switched to transfemoral for reasons including irreducible radial artery loop, severe BCTA and CCA tortuosity, and thrombosis of radial sheath. Eventually 23 (65%) patients had transfemoral and 12 (35%) patients had transradial CAS. Type 1 arch (58% cases) were more common in transradial group whereas type II arch (60% cases) in transfemoral group. In transradial cases, guide catheters used included 6F Envoy Sim-2 XB (75%), R2P destination slender sheath (17%), 6F Cook Shuttle (8%) and stents included Cordis Precise (50% cases) and Wallstent (42% cases) with majority (92% cases) of them being 8 mm width or lower. Mean age was similar between the two groups (72.7 years vs 71.7 years) with 65% of patients being males in both groups. 67% of cases were symptomatic in transradial group against 74% patients in transfemoral group. Carotid lesion was right sided in 58% cases of transradial group as opposed to left sided in 65% of transfemoral cases. Of the symptomatic cases treated transradially (n=8), 4 had non-disabling strokes, 3 had TIA and 1 had amaurosis fugax as treatment indications. Majority of the symptomatic cases were treated <7days from symptom onset in both groups (42% vs 65%). 1 patient (4%) had post-operative decline in NIHSS and 1 patient had a groin hematoma in the transfemoral group and no adverse events noted in the transradial group. The rate of any stroke/death within 30 days post procedure were 0 and 2 (8.7%) in transradial and transfemoral groups respectively. The mean procedure times were 52.3 and 59.5 minutes (p=0.02), whereas mean fluoroscopy times were 28.3 and 30.7 minutes (p=0.34) in transradial and transfemoral groups respectively.

Conclusions Transradial carotid stenting using lower profile technique appears to be a safe, effective, and faster option for carotid revascularization compared to traditional transfemoral approach although conversion rate may be high which can be mitigated through proper case selection.

Disclosures M. Ismail: None. S. Bhagavan: None. O. Qahwash: None. A. Razak: None.