Abstract Body: BACKGROUND: The transradial approach (TRA) using a Simmons catheter has increasingly been employed for diagnostic cerebral angiography and neurointervention. Typically, the right radial artery is used in neurointerventions. However, in interventional cardiology, the left TRA has demonstrated clear clinical benefits, particularly for right-handed patients. To our knowledge, no studies have directly compared the right and left TRA for carotid artery stenting (CAS). This study aimed to evaluate the safety and technical feasibility of left TRA-CAS in comparison to right TRA-CAS.
METHODS: We conducted a retrospective review of consecutive patients who underwent TRA-CAS using a 6-French Simmons guiding sheath between 2019 and 2024. The right TRA was performed as a first-line approach from 2019 to 2021, with the left TRA being used thereafter. Patients who underwent proximal balloon-protected CAS were excluded. We analyzed patient characteristics, clinical outcomes, and the presence of lesions on postprocedural diffusion-weighted imaging (DWI lesions).
RESULTS: A total of 106 patients underwent TRA-CAS, with 46 in the right TRA group and 60 in the left TRA group. The mean age, percentage of male patients, and incidence of symptomatic cases were 73.9 years, 83.7%, and 53.5% in the right TRA group, and 74.8 years, 85.5%, and 45.5% in the left TRA group, respectively, with no significant differences. The two groups exhibited similar patient characteristics, anatomical factors including aortic arch, and clinical outcomes. Crossover to another approach was required in two patients in each group. The number of catheters and wires used, as well as the duration of cannulation from the radial to the targeted common carotid artery, were significantly higher in the right TRA group. Although there was no significant difference in the number of patients with postprocedural DWI lesions in the cerebrum ipsilateral to the carotid lesion, fewer patients in the left TRA group exhibited DWI lesions on the contralateral side of the carotid lesion. All carotid stenoses were successfully dilated. Except for one patient in the right TRA group who developed transient ischemia, no patients experienced symptomatic stroke or other procedural complications.
CONCLUSIONS: Both right and left TRA-CAS were successfully performed with a high success rate. Left TRA may offer a safer and more reliable approach for various aortic arch configurations and for both right- and left-sided carotid lesions.