• Kareem El Naamani, Omaditya Khanna, Amit Syal, Arbaz A Momin, Rawad Abbas, Abdelaziz Amllay, Abhijeet Sambangi, Adam Hunt, Jaime Dougherty, Charles L Lawall, Stavropoula I Tjoumakaris, M Reid Gooch, Nabeel A Herial, Robert H Rosenwasser, Hekmat Zarzour, Richard F Schmidt, and Pascal M Jabbour.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
• Neurosurgery. 2023 Aug 1; 93 (2): 445452445-452.

BackgroundThe transradial (TR) approach has emerged as an alternative to the transfemoral (TF) approach in carotid artery stenting (CAS) because of its perceived benefits in access site complications and overall patient experience.ObjectiveTo assess outcomes of TF vs TR approach for CAS.MethodsThis is a retrospective single-center review of patients receiving CAS through the TR or TF route between 2017 and 2022. All patients with symptomatic and asymptomatic carotid disease who underwent attempted CAS were included in our study.ResultsA total of 342 patients were included in this study: 232 underwent CAS through TF approach vs 110 through the TR route. On univariate analysis, the rate of overall complications was more than double for the TF vs TR cohort; however, this did not achieve statistical significance (6.5% vs 2.7%, odds ratio [OR] = 0.59 P = .36). The rate of cross-over from TR to TF was significantly higher on univariate analysis (14.6 % vs 2.6%, OR = 4.77, P = .005) and on inverse probability treatment weighting analysis (OR = 6.11, P < .001). The rate of in-stent stenosis (TR: 3.6% vs TF: 2.2%, OR = 1.71, P = .43) and strokes at follow-up (TF: 2.2% vs TR: 1.8%, OR = 0.84, P = .84) was not significantly different. Finally, median length of stay was comparable between both cohorts.ConclusionThe TR approach is safe, feasible, and provides similar rates of complications and high rates of successful stent deployment compared with the TF route. Neurointerventionalists adopting the radial first approach should carefully assess the preprocedural computed tomography angiography to identify patients amenable to TR approach for carotid stenting.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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