Anatomical and geometric considerations for transradial versus transfemoral approach to extracranial carotid artery stenting

Background and purposeThe transradial (TR) approach is an alternative to the traditional transfemoral (TF) approach for extracranial carotid artery stenting (eCAS). A successful eCAS may be contingent on the geometry of the great vessels. We aimed to analyze the vessel geometry to identify predictors for successful stent placement, enabling tailored approaches.Materials and methodsMulticenter retrospective data was collected from the electronic health record of patients who underwent eCAS from January 2018 to December 2022. Geometric parameters for great vessels were measured using computed tomography angiography (CTA) or magnetic resonance angiography (MRA). A successful approach was defined as completing eCAS without conversion. We performed a geometric analysis of features correlated with complications and successful completion of eCAS.Results1346 patients underwent TF (1081) and TR (265) eCAS. Conversion from TR to TF occurred in 44 cases (17%). Three TF cases required conversion. Complication rates did not differ between approaches (<i>P</i> = .773), but converting to TF had significantly higher Category 1 complications (<i>P</i> < .001). A smaller angle of origin of the left common carotid artery (A3) correlated with increased complications (<i>P</i> = .039), particularly with angles <90°, peaking at 50°. No other geometric features predicted the success.ConclusionBoth TR and TF stenting can be safely performed for carotid disease, but the angle of the left carotid artery origin predicted an increased risk of complications. No other aortic arch types or great vessel geometry predicted complications. Conversion from TR to TF predicted increased stroke, ICH, and MI.

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Publication Details

Journal
Interventional Neuroradiology
Published
2025-04-04
DOI
https://doi.org/10.1177/15910199251330120
Primary Topic
Vascular Procedures and Complications
Type
article
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article

Anatomical and geometric considerations for transradial versus transfemoral approach to extracranial carotid artery stenting

Maria Martucci, Alberto Maud, Osama O. Zaidat, Samantha E. Miller et al.
Interventional Neuroradiology
Vascular Procedures and Complications
article

Anatomical and geometric considerations for transradial versus transfemoral approach to extracranial carotid artery stenting

Maria Martucci, Alberto Maud, Osama O. Zaidat, Samantha E. Miller, Nazli Janjua, Tunmi Anwoju, Adnan Iqbal Qureshi, Muhammad Khizar Niazi, Ali M. Alaraj, Ramesh Grandhi, Mohamad Ezzeldin, Adam Delora, Oz Haim, M. Shazam Hussain, Saif Bushnaq, S. Shaikh, Amer Alshekhlee, Kaiz Asif, Gautam Edhayan, Faheem Sheriff, Ibrahim A Bhatti, Elsa Nico, Mohammad A Abdulrazzak, Gustavo Rodríguez, Omar Tanweer, Farhan Siddiq, Varun Chaubal, Navpreet Bains, Zuhair Ali, Ameer E Hassan, Walid K. Salah, Malek Mansour, Chizoba Ezepue, Mohammad Almajali, Peter Kan, M. Froukh, Rime Ezzeldin, L. Mealer
article en

Abstract

Background and purposeThe transradial (TR) approach is an alternative to the traditional transfemoral (TF) approach for extracranial carotid artery stenting (eCAS). A successful eCAS may be contingent on the geometry of the great vessels. We aimed to analyze the vessel geometry to identify predictors for successful stent placement, enabling tailored approaches.Materials and methodsMulticenter retrospective data was collected from the electronic health record of patients who underwent eCAS from January 2018 to December 2022. Geometric parameters for great vessels were measured using computed tomography angiography (CTA) or magnetic resonance angiography (MRA). A successful approach was defined as completing eCAS without conversion. We performed a geometric analysis of features correlated with complications and successful completion of eCAS.Results1346 patients underwent TF (1081) and TR (265) eCAS. Conversion from TR to TF occurred in 44 cases (17%). Three TF cases required conversion. Complication rates did not differ between approaches (<i>P</i> = .773), but converting to TF had significantly higher Category 1 complications (<i>P</i> < .001). A smaller angle of origin of the left common carotid artery (A3) correlated with increased complications (<i>P</i> = .039), particularly with angles <90°, peaking at 50°. No other geometric features predicted the success.ConclusionBoth TR and TF stenting can be safely performed for carotid disease, but the angle of the left carotid artery origin predicted an increased risk of complications. No other aortic arch types or great vessel geometry predicted complications. Conversion from TR to TF predicted increased stroke, ICH, and MI.

Interventional Neuroradiology
Texas Tech University (US), Mercy St. Vincent Medical Center (US), Cleveland Clinic (US), Ascension (US), Jordan University of Science and Technology (JO), University of Utah (US), Saint Louis University Hospital (US), University of Illinois Chicago (US), Pomona Valley Hospital Medical Center (US), WellSpan Health (US), Valley Baptist Medical Center (US), St. Luke's Hospital (US), Lone Star College Kingwood (US), The University of Texas Medical Branch at Galveston (US), University of Missouri (US), Alexandria University (EG), Texas Tech University Health Sciences Center (US)
Good health and well-being
Openalex Percentile: Top 90%
Vascular Procedures and Complications
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