Within the past 12 months, the author has received consulting fees or honoraria from Boston Scientific, Medtronic, and Terumo.
The document discusses the advantages of radial artery access over femoral artery access for carotid artery stenting (CAS), including reduced risk of emboli in patients with aortic atherosclerosis, lower rates of access site complications and bleeding, earlier ambulation for patients, and improved patient comfort and satisfaction. Several cases demonstrating transradial CAS procedures are presented. Both radial and ulnar arteries can be used for access. While there is a learning curve for new operators and some procedures may take longer, radial access allows for CAS in complex aortic arch anatomies and avoids complications associated with femoral access
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Disclosure Statement Consulting Fees/Honoraria
1. Ø Consulting Fees/Honoraria
Ø Boston Scientific
Ø Medtronic
Ø Terumo
Within the past 12 months, I or my spouse/partner have had a financial
interest/arrangement or affiliation with the organization(s) listed below:
Affiliation/Financial Relationship Company
Disclosure Statement
3. Femoral approach limitations
Ø Aorto-iliac disease or occlusion
Ø Previous surgical bypass at this level
Ø Diseased and Complex aortic arch with
Ø Tortuous SAA originating from elongated,
or type II, III, or bovine aortic arch
4. Risk of catheter-related emboli in patients with
atherosclerotic debris in the thoracic aorta
Karalis DG et al. Am Heart J. 1996 Jun;131(6):1149-55.
Courtesy of Dr. A. Pacchioni
150. A randomised comparison of TRA and TFA for CAS:
RADCAR (RADial access for CARotid artery stenting) study
Ruzsa Z et al. EuroIntervention 2014;10:381-391
151. Ø Easy access in otherwise very complex aortic arcs
Ø Immediate patient mobilisation
Ø Reduced hypotensive response
Ø No bleeding
Ø Anticoagulation is not an issue
Ø Reduced nursing cost
Ø Outpatient performance in selected cases
Wrist access (radial & ulnar) CAS
ADVANTAGE
152. Ø Significant learning curve for new TRA operators
Ø Sometimes longer procedure for easy case
with type I aortic arch
Ø Proximal PD and larger devices could not
be used freely in all cases
Ø Radial artery occlusion ≈ 10 %
Wrist access (radial & ulnar) CAS
DISADVANTAGE
154. Conclusions
Ø TRA for CAS is feasible and safe when performed
by experienced TRA operator
Ø Easy access for CAS in difficult anatomies
(bovine arch LCCA and most of the innominate
artery take offs)
Ø Allows early patient mobilization
Ø Eliminates bleeding complications
Ø Further studies are needed before recommending
wrist access for endovascular procedures as
primary approach over femoral access