Transradial approach for carotid artery stenting

Carotid artery stenting (CAS) has proved to be a valuable alternative to carotid endarterectomy in patients with carotid artery stenosis. Therefore, avoiding complications becomes crucial in CAS. The results are constantly improving because of the introduction of new embolic protection devices and small calibre stenting systems. For many years, transfemoral approach has been the most common access during CAS, mainly due to its short learning curve and possibility to accept large bore catheters. However, this approach is not always feasible because of vessel pathology or aberrant anatomy of the iliofemoral arteries and the aortic arch. Carotid artery stenting using transradial approach was safe and technically feasible, but limited data exist on radial access in carotid artery stenting. The rationale for the transradial approach was to attempt to reduce the incidence of bleeding complications at the vascular access site and to avoid the necessity for prolonged bed rest. Several pilot studies and one randomised prospective trial have confirmed the safety and efficacy of transradial approach for CAS. This article reports review of literature and our initial experience using the radial artery as access for carotid stenting.