Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study
EuroIntervention 2019; just accepted article published in April 2019. DOI: 10.4244/EIJ-D-19-00023
Sándor Nardai1; Eszter Végh2; Viktor Óriás3; Balázs Nemes4; Júlia Tóth5; Artúr Hüttl6; Kálmán Hüttl7; Avantadil Babunashvili8; Olivier Francois Bertrand9; Béla Merkely10; Zoltán Ruzsa11;
1. Semmelweis University, Heart and Vascular Center; 2. Semmelweis University, Heart and Vascular Center; 3. Kinepict Health Limited, Budapest, Hungary; 4. Semmelweis University, Heat and Vascular; 5. Bács-Kiskun County Hospital,Invasive Cardiology Department, Teaching Hospital Of Szent-Györgyi Albert Medical University Szeged; 6. Semmelweis University, Heart and Vascular Center, Budapest, Hungary; 7. Semmelweis University, Heart and Vascular Center, Budapest, Hungary; 8. Department of Cardiovascular Surgery,Center for Endosurgery and Litotripsy, Moscow, Russian Federation; 9. Quebec Heart-Lung Institute, University Laval, Quebec City, Quebec, Canada; 10. Heart and Vascular Center, Semmelweis University, Budapest, Hungary; 11. Semmelweis University, Heart and Vascular Center, Budapest, Hungary, Bacs-Kiskum County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Gyorgyi Albert Medical University, Kecskemet, Hungary, HUNGARY
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Aims: The aim of our study was to demonstrate the feasibility and safety of the distal transradial approach (DTRA) for carotid artery stenting (CAS).
Methods and results: We included 209 consecutive patients (151 Trans-Radial Access (TRA) and 58 DTRA) treated in a single center by CAS with cerebral protection between 2016 and 2018. DTRA punctures were done by ultrasound guidance, and the carotid artery cannulations were performed using a 6.5 F coronary sheathless guiding catheter. The groups showed similar demographic profile regarding age, gender and comorbidities, however the proportion of symptomatic patients was significantly higher in the DTRA cohort (p < 0.001). Procedural success rate was similarly high in both groups, while the overall complication rate was very low, with no major adverse events and only a few vascular complications. The cannulation times were similar, while the overall procedure length was slightly higher in the DTRA group. The cumulative X-ray dose was similarly low regardless the access used.
Conclusions: DTRA is a safe and effective alternative of conventional trans-radial approach for CAS, with a potential to further improve the patient comfort.