Successful application of left radial access for stenting the right internal carotid artery in a patient with multifocal atherosclerosis: a case report

This article presents a successful clinical case of the endovascular treatment of stenosis of the right internal carotid artery through the left radial access in a patient with multifocal atherosclerosis with the occlusion of both iliac arteries and the right radial artery. Transfemoral access is the conventional access route for carotid stenting. However, this may be problematic because of peripheral vascular disease and numerous anatomical variations of the aortic arch and cervical arteries. Bleeding in the puncture area is the most common complication after carotid artery stenting (CAS) via transfemoral access. The elimination of such complications has been well demonstrated via transradial access in patients undergoing coronary interventions. Thus, transradial access has been evaluated as an alternative strategy for carotid stenting. Currently, the CAS procedure is a fairly routine practice in many centres involved in the treatment of this pathology; however, a small percentage of patients who are contraindicated in carotid endarterectomy who lack standard puncture access to the arteries and have a complex anatomy of the brachiocephalic arteries still remain. In such cases, the question regarding the feasibility of the CAS procedure using non-standard puncture approaches and various techniques for the catheterisation of the brachiocephalic arteries remains relevant. In this case, the left radial access and the Catheter Looping and Retrograde Engagement Technique were used for the catheterisation of the right common carotid artery because of the anatomical features, the patient's refusal toward carotid endarterectomy, and the lack of standard access (femoral and right radial). A distal protection system was used for the brain.