Radiology, Triad Radiology Associates, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, USA
Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Neurointerv Surg. 2022 Feb;14(2):169-173. doi: 10.1136/neurintsurg-2020-017143. Epub 2021 Feb 25.
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.
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.
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.
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.
颈动脉支架置入术（CAS）是一种预防中风的程序，通常从股动脉入路进行。关于经桡动脉入路进行 CAS 的报道采用了与经股动脉 CAS 相似的技术。本文介绍了一种经桡动脉颈动脉支架置入术的简单、低剖面技术的初步经验。
在同一位操作者在 15 个月的时间内连续进行了 55 例择期 CAS 病例（标准（非牛）弓解剖），其中 20 例采用 6F Simmons 2 导引导管进行经桡动脉治疗，这是对最初 20 例患者与 35 例接受择期经股动脉 CAS 治疗的患者进行的回顾性分析。对 CAS 数据库进行了回顾，以评估临床适应证、技术、手术和透视时间以及临床结果。
所有手术均技术上成功（无交叉）。在 30 天内，没有患者的国立卫生研究院卒中量表评分或改良 Rankin 量表评分下降。经桡动脉 CAS 的平均（95%可信区间）手术时间略高于经股动脉 CAS（29.4（26.0 至 32.7）比 23.8（21.2 至 26.4）分钟，p=0.0098）。与经股动脉 CAS 相比，经桡动脉 CAS 的平均（95%CI）透视时间也较高（9.6（8.0 至 11.2）比 6.4（5.4 至 7.4），p=0.0006）。1 例患者出现桡动脉假性动脉瘤，需要择期手术修复。
使用描述的低剖面技术进行经桡动脉颈动脉支架置入术为治疗颈动脉狭窄的一系列手术方法提供了另一种有效选择。对于经验丰富的 CAS 操作者来说，与经股动脉颈动脉支架置入术相比，相对的手术和透视时间可能最初较长，尽管绝对差异较小。
