Transradial carotid artery stenting with proximal embolic protection

Abstract

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.

Safety of Slender 5Fr Transradial Approach for Carotid Artery Stenting With a Novel Nitinol Double-Layer Micromesh Stent

“…9e12 Current challenges for widespread use of radial access for peripheral interventions include limited catheter lengths, specific learning curve, and the inherent limitations of using bulky devices with radial or ulnar arteries. 1,9,10,12,13 However, several groups have reported their experience with carotid stenting and radial access. 2,5,11,12 Transradial approach for carotid artery stenting also offers minimal contact with catheter and aortic arch, which may reduce the risk of stroke, especially with right internal carotid or bovine left internal carotid artery.…”

“…1,9,10,12,13 However, several groups have reported their experience with carotid stenting and radial access. 2,5,11,12 Transradial approach for carotid artery stenting also offers minimal contact with catheter and aortic arch, which may reduce the risk of stroke, especially with right internal carotid or bovine left internal carotid artery. Over the years, we have gained much experience using the right radial or ulnar artery as preferred access for right and left carotid arteries stenting.…”

“…Previous experience with 8Fr Mo-Ma and carotid stenting with other stent types by radial approach has been previously reported. 12 The issue of embolic protection remains controversial. 17 Although we have shown that distal and Mo-Ma embolic protection devices can be used for carotid stenting by radial approach, it is possible that the unique double-layer micromesh design of these stents may obviate the need for systematic embolic protection.…”

A new operative classification of both anatomic vascular variants and physiopathologic conditions affecting transradial cardiovascular procedures

“…First choice treatments are angiotensin converting enzyme inhibitors (ACE-I) [2][3][4][5] and loop diuretics [6]. Loop diuretics have a short duration of action [7] and the pharmacological effects of ACE-I require at least 80% inhibition of that enzyme [7]. Consequently it is important for patients to take their medicines regularly to derive maximum benefit.…”

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Transradial approach (TRA) for coronary diagnostic and interventional procedures is known to shorten hospitalization and dramatically reduce access-site complications [1,2] On such bases, TRA has been successfully adopted not only for coronary interventions and in selected patients, but also for coronary interventions in complex patients [3,4] and for peripheral interventions [5][6][7]. Nevertheless, the average technical failure of transradial approach (TRA) in coronary procedures is 5.8% [2] and is significantly higher than that reported in transfemoral approach.

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