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Original research
Stenting the carotid artery from radial access using a Simmons guide catheter
  1. Don Heck1,
  2. Alec Jost2,
  3. George Howard3
  1. 1Radiology, Triad Radiology Associates, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, USA
  2. 2Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Biostatistics, UAB, Birmingham, Alabama, USA
  1. Correspondence to Dr Don Heck, Radiology, Forsyth Medical Center, Winston-Salem, NC 27103, USA; dvheck66{at}gmail.com

Abstract

Background Carotid artery stenting (CAS) is a procedure for stroke prevention, usually done from femoral artery access. Reports of CAS using radial artery access have adopted techniques similar to those used for transfemoral CAS. Initial experience with a simpler and lower profile technique for transradial carotid stenting is described here.

Methods Of 55 consecutive elective CAS cases with standard (not bovine) arch anatomy performed during a 15 month time period by the same operator, 20 were selected for transradial treatment using a 6 F Simmons 2 guide catheter. This was a retrospective analysis of those initial 20 patients compared with the 35 patients treated with elective transfemoral CAS. The CAS database was reviewed for clinical indications, technique, procedure and fluoroscopy times, and clinical outcomes.

Results All procedures were technically successful (no crossovers). No patient had a decline in National Institutes of Health Stroke Scale score or modified Rankin Scale score within 30 days. Mean (95% CI) procedural times for transradial CAS were slightly higher than transfemoral CAS (29.4 (26.0 to 32.7) vs 23.8 (21.2 to 26.4) min, p=0.0098). Mean (95% CI) fluoroscopy times were also higher for transradial CAS compared with transfemoral CAS (9.6 (8.0 to 11.2) vs 6.4 (5.4 to 7.4), p=0.0006). One patient developed a radial artery pseudoaneurysm which required elective surgical repair.

Conclusion Transradial carotid stenting using the described lower profile technique provides another effective option in the array of surgical procedures for the treatment of carotid artery stenosis. Relative procedural and fluoroscopy times may initially be longer compared with transfemoral carotid stenting for experienced CAS operators, although absolute differences are small.

  • atherosclerosis
  • cervical
  • stent
  • stroke
  • technique

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Footnotes

  • Contributors DH is responsible for the manuscript, and performed all of the cases. AJ assisted with research for manuscript preparation, references, and contributed to writing the manuscript. GH provided critical review of the manuscript and data analysis and statistics, as well as preparation of figures for the manuscript.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local institutional review board.

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available from the corresponding author upon reasonable request (Dheck@triadradiology.com).

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