Postdoctoral Research Fellow Thomas Jefferson University Hospital Philadelphia, Pennsylvania, United States
Introduction: The transradial (TR) approach has emerged as an alternative to the transfemoral (TR) approach in carotid artery stenting (CAS) due to its perceived benefits in access site complications and overall patient experience. In this study we assess outcomes of transfemoral vs transradial approach for carotid artery stenting.
Methods: This is a retrospective single-center review of patients receiving CAS via the TR or TF route between 2017 and 2022. All patients with symptomatic and asymptomatic carotid disease who underwent attempted CAS were included in our study
Results: On univariate analysis, the rate of overall complications was more than double for the TF vs TR cohort, however this did not achieve statistical significance (6.5%vs2.7%, OR=0.59 p=.36). The rate of cross-over from TR to TF was significantly higher on univariate analysis (14.6 %vs2.6%, OR=4.77, p=.005) and on inverse probability treatment weighting analysis (OR= 6.11, p < .001). Modified Rankin Scores (0-2vs3-6) at discharge were comparable between the cohorts (p=.89). The rate of in-stent stenosis (TR:3.6% vs TF:2.2%, OR=1.71, p=.43) and strokes at follow-up (TF:2.2% vs TR:1.8%, OR= 0.84, p=.84) was not significantly different. Lastly, the median length of stay was insignificantly higher in the TF cohort (3 days (1-6) vs 2 days (1-4), p=.06).
Conclusion : The TR approach is safe, feasible, and provides similar rates of complications and high rates of successful stent deployment compared with the TF route. Neurointerventionalists adopting the radial first approach should carefully assess the pre-procedural computed tomography angiography to identify patients amenable to TR approach for carotid stenting.
