Imahori Taichiro, Miyake Shigeru, Maeda Ichiro, Goto Hiroki, Nishii Rikuo, Enami Haruka, Yamamoto Daisuke, Hamaguchi Hirotoshi, Hosoda Kohkichi, Kaneko Naoki, Sakai Nobuyuki, Sasayama Takashi
Department of Neurosurgery, Kitaharima Medical Center, Hyogo, Japan; Department of Neurovascular Research, Kobe City Medical Center General Hospital, Hyogo, Japan; Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
Department of Neurosurgery, Kitaharima Medical Center, Hyogo, Japan.
Ann Vasc Surg. 2025 Aug;117:72-84. doi: 10.1016/j.avsg.2025.03.031. Epub 2025 Apr 15.
The transradial approach (TRA) is a less invasive alternative for carotid artery stenting (CAS). However, limited device availability has restricted its application, and reports on balloon guide catheters (BGCs) in TRA are scarce. This study reports the initial experience with sheathless 8Fr BGC in CAS via TRA.
We retrospectively analyzed cases of CAS performed with a sheathless 8Fr Optimo BGC (Tokai Medical Products, Aichi, Japan) via TRA from April 2023 to November 2024. Patient demographics, procedural details, and outcomes were evaluated. The primary efficacy endpoint was the technical success rate, while the primary safety endpoint was a composite of major access-related complications, stroke, myocardial infarction, and death within 30 days.
A total of 30 cases were included (median age 77 years; 90% male). Symptomatic lesions were present in 42%, with a median stenosis rate of 79%, and 63% involved the right carotid artery. Sheathless BGC insertion and navigation succeeded in 29 cases (97%), with 1 case (3%) requiring conversion to brachial access due to radial artery spasm. Balloon inflation for flow control and device stabilization was performed in 23 cases (77%). CAS was successful in all cases, with no major complications or adverse events.
Our experience suggests that the sheathless 8Fr BGC is safe and feasible for CAS via TRA. This approach preserves the minimally invasive nature of TRA while improving device stability and potentially reducing embolic risk. Further development of TRA-specific low-profile devices may enhance procedural outcomes and broaden adoption in neurointervention.
经桡动脉途径（TRA）是颈动脉支架置入术（CAS）的一种侵入性较小的替代方法。然而，设备可用性有限限制了其应用，且关于TRA中球囊导引导管（BGC）的报道很少。本研究报告了经TRA使用无鞘8Fr BGC进行CAS的初步经验。
我们回顾性分析了2023年4月至2024年11月期间经TRA使用无鞘8Fr Optimo BGC（日本爱知县东海医疗产品公司）进行CAS的病例。评估了患者的人口统计学特征、手术细节和结果。主要疗效终点是技术成功率，而主要安全终点是30天内主要的与入路相关并发症、中风、心肌梗死和死亡的综合情况。
共纳入30例患者（中位年龄77岁；90%为男性）。42%存在有症状性病变，中位狭窄率为79%，63%累及右侧颈动脉。29例（97%）成功插入并操控了无鞘BGC，1例（3%）因桡动脉痉挛需要转为肱动脉入路。23例（77%）进行了球囊扩张以控制血流和稳定装置。所有病例的CAS均成功，无重大并发症或不良事件。
我们的经验表明，无鞘8Fr BGC用于经TRA的CAS是安全可行的。这种方法保留了TRA的微创特性，同时提高了装置稳定性并可能降低栓塞风险。进一步开发TRA专用的低轮廓装置可能会改善手术效果并扩大在神经介入中的应用。
