Proximal embolic protection devices (PPDs) are increasingly used during carotid artery stenting (CAS) due to the theoretical advantage of cerebral protection during the entire procedure. Transradial approach reduces access site vascular complications and can be useful for CAS in patients at high bleeding risk, with contraindications for prolonged bed rest and when a bovine aortic arch is present. Due to the large size of the available equipment, PPDs have only been employed by transfemoral approach. Recently, one PPD (MoMa, Invatec, Roncadelle, Italy) has become available in 8 Fr configuration. Such improved design may theoretically permit its introduction in the radial artery. Here we report three cases of severe internal carotid artery stenosis successfully treated by CAS with 8 Fr MoMa using transradial approach, showing the technical feasibility of such procedure.

In selected patients, complex percutaneous interventions requiring 7-8 Fr sheaths can be successfully performed by RA approach without access-site clinical consequences.

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In the DES era, the use of a last-generation BMS in patients with limited compliance to double antiplatelet therapy, STEMI or SVG interventions, and noncomplex angiographic lesions may be associated with acceptable clinical outcome.

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