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Initial transradial (TR) access in coronary intervention showed a “learning curve” regarding radiation exposure, dye use, and procedural times compared to transfemoral (TF) access. Data are limited in TR access in carotid artery stenting (CAS), and it is unclear whether a similar “learning curve” exists when this approach is chosen.
We compared data of 195 patients from a single center, single operator who performed carotid stenting from 2010 to 2017 with either TF (n=157) or TR (n=38) access. From retrospective chart reviews, statistical analyses were generated. Access site and stent/embolic protection were left to operator discretion.
Baseline clinical characteristics were similar, except that there significantly more men (81.6% vs. 61.8%), higher prior CVAs (39.5% vs. 18.5%) and right CAS (94.3% vs 49.0%) in the TR group. Table 1 demonstrates that procedural success was achieved in all patients, with a crossover rate of 15.8%. Interventional/embolic filter times and contrast use were similar. The TR group had higher fluoroscopy times but comparable cumulative radiation exposure. Hospital adverse events were similar, with one CVA event in the TF group. Blood loss (9.6% vs. 5.3%), acute kidney injury (8.9% vs. 2.6%), and vascular complication rates due to site hematomas (n=2) and pseudoaneurysm (n=1) were higher in the TF group.
Although a “learning curve” is not evident with TR CAS, the crossover rate remains relatively high. However, with reduced vascular complication rates and increased patient comfort, the TR approach should be considered in many patients. Further analyses are required.