Carotid Artery Stenting via Radial Access with Modified Flow Reversal Method: Case Series

Feasibility and radial artery occlusion rate of sheathless distal transradial access using balloon guide catheters

Distal transradial access (dTRA), performed through an anatomical snuffbox, minimizes post-procedural burdens of endovascular treatments. However, despite the benefits of balloon-guide catheters (BGCs), their use in dTRA is limited by their small radial artery diameter. Herein, we evaluated the feasibility and radial artery occlusion (RAO) rate of 8Fr BGCs used in sheathless dTRA. This retrospective study reviewed patients treated with sheathless dTRA using an 8Fr Optimo at a single center between July 2023 and May 2024. dTRA procedures were performed under general anesthesia in patients not requiring urgent treatment. The RAO was assessed using ultrasonography 24 h after the procedure. The demographic and procedural characteristics were compared between the radial artery patency and occlusion groups. Of 170 patients, 50 underwent dTRA, and 43 (86%) completed the procedure. RAO occurred in 12/43 (28%) patients with dTRA. Univariate and receiver operating characteristic curve analyses demonstrated that the median radial artery diameter was significantly smaller in the RAO group (P < 0.001), with an optimal cut-off value of 2.4 mm to predict RAO. Complications included minor cerebral ischemia in two patients, but no severe ischemia was observed. Sheathless dTRA using an 8Fr Optimo BGC is feasible, but the risk of RAO should be noted, particularly in patients with small radial artery diameters. This study suggests a radial artery diameter cutoff value of 2.4 mm to predict RAO, aiding access decisions for large-bore BGC. Further multicenter prospective studies are warranted to confirm these findings and assess long-term outcomes.

Trans-Distal Radial Artery Carotid Revascularization with Forearm Flow Reversal: An Alternative Option of CAS in the TCAR Era

BACKGROUND

Transcarotid artery revascularization (TCAR) has emerged as an alternative to carotid artery stenting (CAS). TCAR demonstrated its superiority by avoiding femoral artery puncture and establishing proximal protection without crossing the stenotic lesion. In the TCAR era, we focused on the possibility of a trans-distal radial approach (DRA). A balloon-guide catheter was navigated via DRA to establish proximal protection before lesion crossing. The forearm subcutaneous vein was used as the flow-reversal circuit.

METHODS

Six internal carotid artery stenosis patients underwent CAS using "the forearm flow reversal technique." Every procedure was performed under continuous flow reversal from the common carotid artery to the forearm cephalic vein.

RESULTS

Successful revascularization was achieved without ischemic or access-site complications. The distal radial artery was patent at discharge in all cases.

CONCLUSIONS

Trans-distal radial CAS with forearm flow reversal is a feasible and less invasive technical option.