Transradial Approach Just as Safe, Effective as Transfemoral for Carotid Artery Stenting

San Francisco, CA—Carotid artery stenting is equally safe and effective when performed via transradial or transfemoral access, according to results of a prospective, randomized trial presented at TCT. Though crossover from transradial was high, increased experience likely would lessen this issue, researchers say.

Zoltan Ruzsa, MD, PhD, of Semmelweis University in Budapest, Hungary, and colleagues looked at 260 consecutive patients who underwent carotid stenting using cerebral protection at two Hungarian centers and one German center between 2010 and 2012. The patients, all considered to be at high risk for carotid endarterectomy, were randomly assigned to either transradial (n=130) or transfemoral (n=130) access, with major adverse cardiac or cerebral events (MACCE) and access-site complications as the primary endpoints.

Procedural success was achieved in all patients, and rates of MACCE and major access-site complications did not differ between the groups. There were, however, differences with regard to crossover rate and hospitalization time (see Table).

Procedure times were also similar in the two groups at 1,744±744 seconds in transradial patients and 1,665±744 seconds in transfemoral patients (P=NS). Fluoroscopy times were also equivalent at 613±289 seconds vs. 579±285 seconds (P=NS), though the radiation dose was significantly higher for transradial patients (223±138 Gy/cm2 vs. 182±106 Gy/cm2; P<.05).

“The take-home message of the study is that transradial access is safe and efficacious for protected carotid artery stenting,” Ruzsa told TCT Daily. He noted that the higher crossover rate was largely due to difficult cannulation (55%), and that, after a short learning period, operators became more accustomed to transradial access toward the end of the study. “We believe that the crossover rate can be lower in the future with dedicated guidewires for the transradial technique, and with preoperative 3-D angio-CT scans from the aortic arch,” he said.

According to Ruzsa, the higher radiation dose will likely come down as well as more experience with transradial is gained.

“It was confirmed in many studies that the transradial technique has [fewer] vascular complications than the transfemoral route,” Ruzsa said. “Therefore, in patients with severe obesity and known peripheral artery disease, this is the primary access route for carotid artery stenting.” He reported that a new study comparing the two approaches with regard to neurological events and cerebral microembolization is in the planning stages.

Study details

Patients in the two groups of this study were well matched with regard to mean age (66.8 years vs. 66.7 years), diabetes status (36.2% vs. 36.9%), smoking status (28.5% vs. 26.9%) and other baseline characteristics. But compared with the transradial group, more patients in the transfemoral group were obese (34.6% vs. 14.6%; P=.0003) and had hypertension (88.5% vs. 77.7%; P=.021).

Disclosures:

Ruzsa reports no relevant conflicts of interest.