Transradial approach in carotid stenting

Shchanitsyn I.N., Sharafutdinov M.R., Yakubov R.A., Larin I.V.

Scientific Research Institute for Traumatology, Orthopaedics and Neurosurgery of the Saratov State Medical University named after V.I. Razumovsky, Saratov, Russia

A femoral approach is the main access in stenting of carotid arteries, mainly due to rapid training in how to perform the procedure and a possibility of using large-diameter catheters. However, this approach is not always feasible in atherosclerosis, tortuosity of lower-limb arteries and in certain anatomical peculiarities of the aortic arch. Using a transradial approach is based on the desire to diminish the incidence rate of haemorrhagic complications in the zone of the puncture and to avoid the necessity of a long-term bed rest. The findings obtained in numerous studies of coronary stenting and in a series of works on stenting of carotid arteries have demonstrated that the transradial approach reduces the risk of haemorrhage and local vascular complications.

Our study was aimed at comparative analysis of the transradial versus transfemoral approache used in carotid stenting.

We retrospectively analysed the results of transradial and transfemoral stenting of carotid arteries in a total of 168 patients. The operations had been performed in two centres over the period from 2012 to 2017. We evaluated the clinical and angiographic data, technical aspects of the operations, as well as the outcomes and complications. In particular, we compared such complications as stroke, transitory ischaemic attack, myocardial infarction and local complications of the approach. We carried out a univariate analysis of the risk for the development of complications depending on the method of the approach.

Stenting of carotid arteries had been performed in 75 patients through the radial approach and in 93 patients via the femoral one. Comparing the two groups, the main clinical and angiographic data appeared to have no statistically significant differences. Various techniques of catheterization had been used depending upon anatomical peculiarities. The success of the procedure was achieved in 100% of cases, with the frequency of conversion amounting to 4% for the radial approach and to 1% for the femoral one (p=0.087). Amongst complications encountered, disabling stroke was revealed in two (1.2%) patients and minor stroke in four (2.4%). The groups did not differ by the incidence of neurological complications. Within 30 postoperative days neither lethal outcomes nor myocardial infarction were registered. Neither were there haemorrhagic events or other approach-related complications, however in the transradial-approach group, seven (9.3%) patients were found to have developed asymptomatic occlusions of the radial artery. The duration of the operation, the radiation load, and the length of hospital stay had no statistically significant differences depending on the approach used.

Hence, the transradial approach is an effective and safe method in stenting of carotid arteries. In patients with high risk of haemorrhagic complications from the side of the vascular approach and with difficult anatomy of the aortic arch and its branches, hampering catheterization of the carotid artery via the femoral approach, the radial artery may be considered as an advantageous site of access.

KEY WORDS: carotid stenting, transradial approach, transfemoral approach, complications of endovascular intervention.

P. 122

« Back